Provider Demographics
NPI:1588394563
Name:SORRENTINO, ANNELIESE EVA HELENE (MSS, LMFT)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:EVA HELENE
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:MSS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1212
Mailing Address - Country:US
Mailing Address - Phone:610-766-2963
Mailing Address - Fax:
Practice Address - Street 1:4025 CHESTNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3054
Practice Address - Country:US
Practice Address - Phone:215-382-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist