Provider Demographics
NPI:1992433783
Name:SOSA, OLGA ARACELY (PSY D, LEP)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:ARACELY
Last Name:SOSA
Suffix:
Gender:F
Credentials:PSY D, LEP
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:SOSA-ESTRELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSY D
Mailing Address - Street 1:601 N E ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0020
Mailing Address - Country:US
Mailing Address - Phone:626-487-0686
Mailing Address - Fax:
Practice Address - Street 1:601 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0020
Practice Address - Country:US
Practice Address - Phone:626-487-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3284103TB0200X, 103TC1900X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities