Provider Demographics
NPI:1881921070
Name:SOBCZAK, JANET A (PHD, PMHNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:A
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 BUCKLEY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2649
Mailing Address - Country:US
Mailing Address - Phone:315-452-0485
Mailing Address - Fax:315-452-0491
Practice Address - Street 1:12 ALFRED ST STE 200
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1915
Practice Address - Country:US
Practice Address - Phone:781-646-0500
Practice Address - Fax:781-646-7130
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN180847363LP0808X
NYF401268-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid