Provider Demographics
NPI:1386377026
Name:TORNABENE, SOPHIA ROSE (LSW)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ROSE
Last Name:TORNABENE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WEWATTA WAY APT 547
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3778
Mailing Address - Country:US
Mailing Address - Phone:718-689-0701
Mailing Address - Fax:
Practice Address - Street 1:2590 WELTON ST STE 200-1005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3300
Practice Address - Country:US
Practice Address - Phone:720-923-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099308621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLSW.0009924223OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
COCSW.09930862OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES