Provider Demographics
NPI:1881102127
Name:SOFIO WOOLCOTT, FERNANDA (PHD)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:SOFIO WOOLCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:FERNANDA
Other - Middle Name:
Other - Last Name:SOFIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:360 NASSAU ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4646
Mailing Address - Country:US
Mailing Address - Phone:609-566-8491
Mailing Address - Fax:
Practice Address - Street 1:360 NASSAU STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NEW JERSEY
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-647-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00739600103TC0700X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst