Healthcare Provider Details

I. General information

NPI: 1477641140
Provider Name (Legal Business Name): JUDITH SOUWEINE ED,D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BREWSTER CT
NORTHAMPTON MA
01060-3801
US

IV. Provider business mailing address

565 BAY RD
AMHERST MA
01002-3504
US

V. Phone/Fax

Practice location:
  • Phone: 413-587-3265
  • Fax: 413-587-3268
Mailing address:
  • Phone: 413-587-3265
  • Fax: 413-587-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3632
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: