Provider Demographics
NPI:1437846359
Name:ANDEMICAEL-MAYEVSKIY, SOFYA DAWIT
Entity type:Individual
Prefix:MRS
First Name:SOFYA
Middle Name:DAWIT
Last Name:ANDEMICAEL-MAYEVSKIY
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 1:199 PIERCE ST APT 1127
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1266
Mailing Address - Country:US
Mailing Address - Phone:908-930-7819
Mailing Address - Fax:
Practice Address - Street 1:190 ROUTE 18 STE 304
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1407
Practice Address - Country:US
Practice Address - Phone:732-333-8520
Practice Address - Fax:732-333-8530
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07111000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty