Healthcare Provider Details

I. General information

NPI: 1457739583
Provider Name (Legal Business Name): COURTNEY LYNNE SOUZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOPMEADOW ST
WEATOGUE CT
06089
US

IV. Provider business mailing address

225 HOPMEADOW ST
WEATOGUE CT
06089-9782
US

V. Phone/Fax

Practice location:
  • Phone: 860-658-0465
  • Fax: 860-658-5963
Mailing address:
  • Phone: 860-658-0465
  • Fax: 860-658-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number064738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: