Provider Demographics
NPI:1760216287
Name:TIMIN, SOPHIE SHOSHANNA
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:SHOSHANNA
Last Name:TIMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:GABRIELA
Other - Last Name:TIMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6317
Mailing Address - Country:US
Mailing Address - Phone:350-815-7080
Mailing Address - Fax:
Practice Address - Street 1:310 E MAGNOLIA ST UNIT 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4580
Practice Address - Country:US
Practice Address - Phone:360-820-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician