Provider Demographics
NPI:1285162511
Name:SOFARELLI, RACHEL MARIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:SOFARELLI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 45TH STREET NORTH
Mailing Address - Street 2:BUILDING C
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714
Mailing Address - Country:US
Mailing Address - Phone:727-748-4060
Mailing Address - Fax:
Practice Address - Street 1:495 44TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5021
Practice Address - Country:US
Practice Address - Phone:727-748-4060
Practice Address - Fax:727-748-4060
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024240800Medicaid