Provider Demographics
NPI:1528428307
Name:KONVITZ, SOFIA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:KONVITZ
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 1:743 PASSAIC AVE
Mailing Address - Street 2:APT 109
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:743 PASSAIC AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:908-461-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst