Healthcare Provider Details

I. General information

NPI: 1558095018
Provider Name (Legal Business Name): JULIE MARIE SOUSA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CANAL ST STE 142P
SALEM MA
01970-4673
US

IV. Provider business mailing address

12 HIGH ST
MALDEN MA
02148-7006
US

V. Phone/Fax

Practice location:
  • Phone: 978-548-6288
  • Fax:
Mailing address:
  • Phone: 413-896-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10002017
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: