Healthcare Provider Details

I. General information

NPI: 1184532871
Provider Name (Legal Business Name): JOHN DAVID SOUCY JR. MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ZACHARY RD
MANCHESTER NH
03109-5607
US

IV. Provider business mailing address

200 ZACHARY RD
MANCHESTER NH
03109-5607
US

V. Phone/Fax

Practice location:
  • Phone: 603-206-6675
  • Fax: 603-647-8426
Mailing address:
  • Phone: 603-206-6675
  • Fax: 603-647-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1259
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: