Provider Demographics
NPI:1821865668
Name:WEBSTER, SOPHIA ROSEMARIE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROSEMARIE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2164
Mailing Address - Country:US
Mailing Address - Phone:860-729-6818
Mailing Address - Fax:
Practice Address - Street 1:106 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2164
Practice Address - Country:US
Practice Address - Phone:860-729-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program