Provider Demographics
NPI:1194583658
Name:ROUNDTREE, SONYA LOUISE (LICSW)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:LOUISE
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-265 FARRINGTON HWY APT 415
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-1804
Mailing Address - Country:US
Mailing Address - Phone:808-990-4053
Mailing Address - Fax:
Practice Address - Street 1:84-265 FARRINGTON HWY APT 415
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-1804
Practice Address - Country:US
Practice Address - Phone:808-990-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-5012-01041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical