Provider Demographics
NPI:1306649470
Name:IRENE SOFIA THERAPY LCSW PC
Entity type:Organization
Organization Name:IRENE SOFIA THERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:KOUTSIDIS-MARTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-256-4597
Mailing Address - Street 1:13430 SITKA ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2436
Mailing Address - Country:US
Mailing Address - Phone:347-403-2102
Mailing Address - Fax:
Practice Address - Street 1:13430 SITKA ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2436
Practice Address - Country:US
Practice Address - Phone:347-403-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)