Provider Demographics
NPI:1609297498
Name:SOVIA THERAPY, LLC
Entity type:Organization
Organization Name:SOVIA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:717-379-4543
Mailing Address - Street 1:1015 TIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7699
Mailing Address - Country:US
Mailing Address - Phone:717-379-4543
Mailing Address - Fax:717-732-3740
Practice Address - Street 1:1015 TIVERTON RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7699
Practice Address - Country:US
Practice Address - Phone:717-379-4543
Practice Address - Fax:717-732-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002751L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026813350002Medicaid
PA1028563980001Medicaid
PA0019283190003Medicaid
PA1022391420002Medicaid
PA1025619720001Medicaid
PA1025209420001Medicaid
PA1028468290001Medicaid
PA1027475710001Medicaid