Provider Demographics
NPI:1427424860
Name:GRODOTZKE, SOPHIA CARINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:CARINA
Last Name:GRODOTZKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SOPHIA
Other - Middle Name:CARINA
Other - Last Name:CORNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3828 20TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-4623
Mailing Address - Country:US
Mailing Address - Phone:631-371-4524
Mailing Address - Fax:
Practice Address - Street 1:3828 20TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-4623
Practice Address - Country:US
Practice Address - Phone:631-371-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker