Provider Demographics
NPI:1194294736
Name:DEMORIZI, SOPHIA (PSYD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:DEMORIZI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 QUENTIN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4245
Mailing Address - Country:US
Mailing Address - Phone:305-962-3385
Mailing Address - Fax:
Practice Address - Street 1:1848 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2875
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10319103TC0700X
NY023351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY10319OtherSTATE LICENSE