Provider Demographics
NPI:1043928575
Name:SOFFER, REBECCA LIORA (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LIORA
Last Name:SOFFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SAN PABLO AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2276
Mailing Address - Country:US
Mailing Address - Phone:510-282-5710
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVE STE 5
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2276
Practice Address - Country:US
Practice Address - Phone:510-282-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22279103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent