Provider Demographics
NPI:1699443887
Name:SUTKER, SOPHIE (PSYD, HSPP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:SUTKER
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 SHERIDAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3554
Mailing Address - Country:US
Mailing Address - Phone:917-310-5276
Mailing Address - Fax:
Practice Address - Street 1:4310 SHERIDAN ST STE 202
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3554
Practice Address - Country:US
Practice Address - Phone:917-310-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025306-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty