Provider Demographics
NPI:1780927202
Name:SOZIO, JOHANNA M (P86890)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:M
Last Name:SOZIO
Suffix:
Gender:F
Credentials:P86890
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 8TH AVE RM 906
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4190
Mailing Address - Country:US
Mailing Address - Phone:212-679-4960
Mailing Address - Fax:
Practice Address - Street 1:1140 KILDAIRE FARM RD STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4596
Practice Address - Country:US
Practice Address - Phone:984-263-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP86890OtherCREDENTIALS