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Organization
SONDERMIND PC
Active
Organization
SONDERMIND PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA ROACH (CHIEF ADMINISTRATIVE CRED OFFICER)
(844) 843-7279
Entity
Organization
Contact information
Practice address
6203 SAN IGNACIO AVE STE 110, SAN JOSE, CA 95119-1358
(844) 843-7279
Mailing address
6203 SAN IGNACIO AVE STE 110, SAN JOSE, CA 95119-1358
(844) 843-7279
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/06/2024
Last updated
11/22/2024
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