Provider Demographics
NPI:1053546119
Name:JENSEN, SOFIA K (MD)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:K
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W LANCASTER AVE # 1020
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3401
Mailing Address - Country:US
Mailing Address - Phone:610-215-7050
Mailing Address - Fax:610-273-5986
Practice Address - Street 1:191 PRESIDENTIAL BLVD STE W10
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1205
Practice Address - Country:US
Practice Address - Phone:610-215-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195441390200000X
PAMD4439572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program