Provider Demographics
NPI:1174870653
Name:FANA SOGORKA, ALICIA JEAN (MA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:FANA SOGORKA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JEAN
Other - Last Name:SOGORKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1873 CORNELIA STREET
Mailing Address - Street 2:APT #1R
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5019
Mailing Address - Country:US
Mailing Address - Phone:973-699-1035
Mailing Address - Fax:
Practice Address - Street 1:111 LIVINGSTON ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5078
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist