Provider Demographics
NPI:1447028980
Name:PONTE, SOPHIA ISABELLA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ISABELLA
Last Name:PONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HILLER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-4024
Mailing Address - Country:US
Mailing Address - Phone:508-789-3136
Mailing Address - Fax:
Practice Address - Street 1:31 HILLER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4024
Practice Address - Country:US
Practice Address - Phone:508-789-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician