Provider Demographics
NPI:1760790463
Name:VASSELL, SONIA MERLE (MA)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:MERLE
Last Name:VASSELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 SCARLETT SAGE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5533
Mailing Address - Country:US
Mailing Address - Phone:407-656-0495
Mailing Address - Fax:
Practice Address - Street 1:12423 SCARLETT SAGE CT
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5533
Practice Address - Country:US
Practice Address - Phone:407-656-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker