Provider Demographics
NPI:1780276493
Name:FORESE, SOPHIA GIACINTA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GIACINTA
Last Name:FORESE
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 1:16232 BRECKINMORE LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-1004
Mailing Address - Country:US
Mailing Address - Phone:813-997-5782
Mailing Address - Fax:813-709-8562
Practice Address - Street 1:1866 JIM REDMAN PKWY # 1025
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6914
Practice Address - Country:US
Practice Address - Phone:813-776-0010
Practice Address - Fax:813-709-8562
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW221181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty