Sofia Graham, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005529 Issued in VA

Practice address

222 Catoctin Cir SE Ste 126
Leesburg, VA 20175-3730

Phone

(714) 771-6135

NPI assigned

Sep 22, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Sofia Nordgren Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northern Lights Psychotherapy

  • Clinical Psychologist
  • Leesburg, VA
  • NPI 1104450105
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1104228121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24400 MOON GLADE CT",
            "city": "ALDIE",
            "state": "VA",
            "postal_code": "201053148",
            "telephone_number": "571-379-6668",
            "fax_number": "703-777-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 CATOCTIN CIR SE STE 126",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201753730",
            "telephone_number": "714-771-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "SOFIA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-22",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOFIA",
            "last_name": "NORDGREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gooya Goudarzi, OD
• Shannon M Gould
• Maria Cecilia Grady, P.T.
• Grafton School, Inc.
• Grafton, Inc
• Erin Ann Gramlich, CCC-SLP
• Summer N Gratia
• Kimberly Kay Graves, MS
• Victoria L Gray-Bailey
• Brooke Lorrin Shamblin Gray, FNP

• Clinical Psychologist in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.