MEDICARE: DR. EMIL SOUCAR ED.D.

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	103TC0700X	Clinical Psychologist	35S100164400	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1558349605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMIL SOUCAR ED.D.

Provider Business Mailing Address
First Line	:	175 W COHAWKIN RD STE C
Second Line	:
City	:	CLARKSBORO
State	:	NJ
Zip	:	08020-1145
Country	:	US
Telephone Number	:	856-423-7700
Fax Number	:	856-423-0823

Provider Business Practice Location Address
First Line	:	305 LENAPE TRL
Second Line	:
City	:	WENONAH
State	:	NJ
Zip	:	08090-2010
Country	:	US
Telephone Number	:	856-468-7767
Fax Number	:	856-468-7767

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

Provider Enumeration Date	:	01/07/2006
Last Update Date	:	08/24/2020

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