Provider Demographics
NPI:1982365664
Name:PERTOSOFF, ARIEL ZARA
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:ZARA
Last Name:PERTOSOFF
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 1:2477 STICKNEY POINT RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6850
Mailing Address - Country:US
Mailing Address - Phone:941-893-7383
Mailing Address - Fax:
Practice Address - Street 1:2477 STICKNEY POINT RD STE 200A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6850
Practice Address - Country:US
Practice Address - Phone:941-893-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW191171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty