Provider Demographics
NPI:1912623067
Name:SOVA, CHRISTOPHER CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:SOVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3139
Mailing Address - Country:US
Mailing Address - Phone:716-807-9657
Mailing Address - Fax:
Practice Address - Street 1:1416 SWEET HOME RD STE 3
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2784
Practice Address - Country:US
Practice Address - Phone:716-807-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025307103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist