Basic Information
Provider Information
NPI: 1013561364
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOSNA
FirstName: SACHI
MiddleName: LILY
NamePrefix:  
NameSuffix:  
Credential: AMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2116 ARLINGTON AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900181353
CountryCode: US
TelephoneNumber: 3233349000
FaxNumber:  
Practice Location
Address1: 2116 ARLINGTON AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900181353
CountryCode: US
TelephoneNumber: 3233349000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/25/2019
LastUpdateDate: 03/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X120242CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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