Provider Demographics
NPI:1043989635
Name:POLIN, SOPHIA (MS)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:POLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S SAINT BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3310
Mailing Address - Country:US
Mailing Address - Phone:347-988-2751
Mailing Address - Fax:
Practice Address - Street 1:233 S 6TH ST STE C33
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3763
Practice Address - Country:US
Practice Address - Phone:267-324-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health