Provider Demographics
NPI:1043460561
Name:SOMA, JOSEPH J JR (MA, MS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:SOMA
Suffix:JR
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S BROADWAY ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5963
Mailing Address - Country:US
Mailing Address - Phone:303-618-9140
Mailing Address - Fax:
Practice Address - Street 1:825 S BROADWAY ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5963
Practice Address - Country:US
Practice Address - Phone:303-618-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional