Healthcare Provider Details

I. General information

NPI: 1497661359
Provider Name (Legal Business Name): SOPHIA DESOUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-5293
US

IV. Provider business mailing address

5 TARPAULIN WAY
WAREHAM MA
02571-2629
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-9116
  • Fax:
Mailing address:
  • Phone: 774-218-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: