Healthcare Provider Details

I. General information

NPI: 1831334853
Provider Name (Legal Business Name): LISA ANN SOUZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 N 6TH ST SUITE 300
NEW BEDFORD MA
02740-6125
US

IV. Provider business mailing address

73 INDEPENDENT ST
NEW BEDFORD MA
02744-1805
US

V. Phone/Fax

Practice location:
  • Phone: 774-929-7420
  • Fax:
Mailing address:
  • Phone: 508-596-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number214950
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: