Provider Demographics
NPI:1639772791
Name:AIZIN, SOPHIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:AIZIN
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 1:408 MAMARONECK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2613
Mailing Address - Country:US
Mailing Address - Phone:929-255-4693
Mailing Address - Fax:
Practice Address - Street 1:70 W 95TH ST APT 14D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6725
Practice Address - Country:US
Practice Address - Phone:929-255-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical