Provider Demographics
NPI:1588439046
Name:WOODS, SOPHIA GRACE (MS, MTBC, CAT-LP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GRACE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MS, MTBC, CAT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 12TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4961
Mailing Address - Country:US
Mailing Address - Phone:315-529-9031
Mailing Address - Fax:
Practice Address - Street 1:541 BAY RIDGE PKWY STE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3309
Practice Address - Country:US
Practice Address - Phone:929-200-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125893225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist