Provider Demographics
NPI:1194408377
Name:SORN, EMILY MARIE
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARIE
Last Name:SORN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 LA VETA CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3635
Mailing Address - Country:US
Mailing Address - Phone:209-985-0825
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-525-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)