1285162511 NPI number — MRS. RACHEL MARIE SOFARELLI BCBA

Table of content: MRS. RACHEL MARIE SOFARELLI BCBA (NPI 1285162511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285162511 NPI number — MRS. RACHEL MARIE SOFARELLI BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOFARELLI
Provider First Name:
RACHEL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285162511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5185 45TH STREET NORTH
Provider Second Line Business Mailing Address:
BUILDING C
Provider Business Mailing Address City Name:
ST. PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-748-4060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 44TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33703-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-748-4060
Provider Business Practice Location Address Fax Number:
727-748-4060
Provider Enumeration Date:
05/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024240800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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