MEDICARE: SALLY SOULIERE 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
1	1041C0700X	Clinical Social Worker	1026857	MA

General Provider Information

NPI Number	:	1134133549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY SOULIERE MSW

Provider Business Mailing Address
First Line	:	1 FATHER DEVALLES BLVD
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1511
Country	:	US
Telephone Number	:	774-294-5055
Fax Number	:	508-567-0407

Provider Business Practice Location Address
First Line	:	1 FATHER DEVALLES BLVD
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1511
Country	:	US
Telephone Number	:	774-294-5055
Fax Number	:	508-567-0407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	11/09/2016

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