Provider Demographics
NPI:1255992673
Name:SORIANO, JUSTIN A (LMSW, T-LMAC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:A
Last Name:SORIANO
Suffix:
Gender:M
Credentials:LMSW, T-LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8778
Mailing Address - Country:US
Mailing Address - Phone:316-283-6103
Mailing Address - Fax:316-283-1333
Practice Address - Street 1:720 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8778
Practice Address - Country:US
Practice Address - Phone:316-283-6103
Practice Address - Fax:316-283-1333
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS789101YA0400X
KS062601041C0700X, 1041C0700X
KS11467104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker