Provider Demographics
NPI:1972068963
Name:SORENSEN, STEPHANIE I (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:I
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 W 121ST ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6474
Mailing Address - Country:US
Mailing Address - Phone:646-436-7175
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 801
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5655
Practice Address - Country:US
Practice Address - Phone:646-418-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical