Provider Demographics
NPI:1215795315
Name:MAKARENKO, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:MAKARENKO
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 1:4345 US HIGHWAY 9 STE 7
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4206
Mailing Address - Country:US
Mailing Address - Phone:609-450-3522
Mailing Address - Fax:
Practice Address - Street 1:4345 US HIGHWAY 9 STE 7
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4206
Practice Address - Country:US
Practice Address - Phone:609-450-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44C056987001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical