Healthcare Provider Details

I. General information

NPI: 1306777537
Provider Name (Legal Business Name): HEATHER L SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 ACUSHNET AVE
NEW BEDFORD MA
02745-3636
US

IV. Provider business mailing address

366 DIVISION ST
FALL RIVER MA
02721-7225
US

V. Phone/Fax

Practice location:
  • Phone: 508-990-0894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: