Provider Demographics
NPI:1356492441
Name:TAYLOR, SONYA TRUDI (LCSW)
Entity type:Individual
Prefix:MISS
First Name:SONYA
Middle Name:TRUDI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4749
Mailing Address - Country:US
Mailing Address - Phone:321-951-3131
Mailing Address - Fax:321-951-3131
Practice Address - Street 1:1900 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4749
Practice Address - Country:US
Practice Address - Phone:321-951-3131
Practice Address - Fax:321-951-3131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4744104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker