Active NPI
Sophia Koutsounadis
- Developmental Therapist
- Fresh Meadows, NY
National Provider Identifier
1376982561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 1409879
- Practice address
- 16216 Union Tpke
303
Fresh Meadows, NY 11366-1958 - Phone
- (718) 264-7250
- NPI assigned
- Jun 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Developmental Therapist | 222Q00000X | 1409879 | NY | Primary |
Addresses
Primary practice location
16216 Union Tpke
303
Fresh Meadows, NY 11366-1958
Mailing address
16216 Union Tpke
303
Fresh Meadows, NY 11366-1958
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1409879 | NY | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540857600000",
"number": "1376982561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16216 UNION TPKE",
"address_2": "303",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113661958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16216 UNION TPKE",
"address_2": "303",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113661958",
"telephone_number": "718-264-7250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUTSOUNADIS",
"first_name": "SOPHIA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-20",
"last_updated": "2018-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "NY",
"license": "1409879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.