Provider Demographics
NPI:1043398084
Name:DETTMANN, SONIA (LICSW)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:DETTMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BERKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1417
Mailing Address - Country:US
Mailing Address - Phone:617-492-6497
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:GENERAL PSYCH ASSOC STE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3723
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:978-475-7620
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10258121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical