Provider Demographics
NPI:1003610346
Name:HAWKINS, SOPHIA MARIE
Entity type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:SOPHIA
Other - Middle Name:MARIE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:1997 ROUTE 17M STE 9
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5233
Mailing Address - Country:US
Mailing Address - Phone:845-294-4787
Mailing Address - Fax:
Practice Address - Street 1:1997 ROUTE 17M STE 9
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5233
Practice Address - Country:US
Practice Address - Phone:845-294-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program