Provider Demographics
NPI:1023511292
Name:LORAN, SOFIA ASHLEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:ASHLEY
Last Name:LORAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAZEL TER STE 20
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2240
Mailing Address - Country:US
Mailing Address - Phone:203-293-7763
Mailing Address - Fax:203-693-4613
Practice Address - Street 1:30 HAZEL TER STE 20
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-293-7763
Practice Address - Fax:203-693-4613
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235900Medicaid