Provider Demographics
NPI:1902146186
Name:SORENTO, JOANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:SORENTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:SORENTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-0524
Mailing Address - Country:US
Mailing Address - Phone:208-726-1903
Mailing Address - Fax:
Practice Address - Street 1:323 LEWIS ST.
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical