Healthcare Provider Details

I. General information

NPI: 1780914481
Provider Name (Legal Business Name): AMANDA MARIE SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 TROY ST
FALL RIVER MA
02720-3023
US

IV. Provider business mailing address

66 TROY ST
FALL RIVER MA
02720-3023
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-5708
  • Fax: 508-676-1948
Mailing address:
  • Phone: 508-676-5708
  • Fax: 508-676-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: