Provider Demographics
NPI:1134862121
Name:SALAS, SOPHIA A (SAC-IT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:A
Last Name:SALAS
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MERCER ST APT A601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1177
Mailing Address - Country:US
Mailing Address - Phone:414-391-9820
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E STE 1005
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3237
Practice Address - Country:US
Practice Address - Phone:414-391-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19674-130101YA0400X
NYP137660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)