Provider Demographics
NPI:1790348712
Name:CAVALCANTI DE ALBUQUERQUE SERPA, SOPHIA (PSYD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CAVALCANTI DE ALBUQUERQUE SERPA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:SERPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:7601 IMPERIAL HWY # 2049
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-385-8181
Mailing Address - Fax:
Practice Address - Street 1:7601 IMPERIAL HWY # 2049
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-385-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30623103TR0400X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth