Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6193 | MA |
Y | 103TC0700X | Clinical Psychologist | 6193 | MA |
NPI | 1013066554 |
---|---|
Provider Name | Dr. Dale Sokoloff |
First Address | Wellesley, MA 02482-6418 |
Second Address | Wellesley, MA 02482-6418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6193 | STATE LICENSE (01) | MA |
W04934 | (02) |