Provider Demographics
NPI:1588049274
Name:JASON SORIANO, PSY.D., P.C.
Entity type:Organization
Organization Name:JASON SORIANO, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-520-0927
Mailing Address - Street 1:973 FEATHERSTONE RD STE 360
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5908
Mailing Address - Country:US
Mailing Address - Phone:815-520-0927
Mailing Address - Fax:815-345-2162
Practice Address - Street 1:973 FEATHERSTONE RD STE 360
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5908
Practice Address - Country:US
Practice Address - Phone:815-520-0927
Practice Address - Fax:815-345-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009069251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health