Provider Demographics
NPI:1720476153
Name:AKASOFU, MASAE
Entity Type:Individual
Prefix:
First Name:MASAE
Middle Name:
Last Name:AKASOFU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2541
Mailing Address - Country:US
Mailing Address - Phone:845-452-3387
Mailing Address - Fax:845-452-3682
Practice Address - Street 1:15 FORTUNE ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2005
Practice Address - Country:US
Practice Address - Phone:845-240-7707
Practice Address - Fax:845-337-3678
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP919901041C0700X
NY007626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical