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NPI Code Detail

MEDICARE: DEEDEE SOUZA MSW

MEDICARE: DEEDEE SOUZA MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerNH 187NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053489617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEDEE SOUZA MSW
Provider Business Mailing Address
First Line : 19 HERITAGE DR
Second Line :
City : BEDFORD
State : NH
Zip : 03110-6014
Country : US
Telephone Number : 603-472-5248
Fax Number : 603-624-1884
Provider Business Practice Location Address
First Line : 753 CHESTNUT ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-3011
Country : US
Telephone Number : 603-668-0660
Fax Number : 603-624-1884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 07/08/2007

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