Healthcare Provider Details

I. General information

NPI: 1457530578
Provider Name (Legal Business Name): THOMAS VINCENT SOUSA L..C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 LONG VALLEY DRIVE EXT
CORAOPOLIS PA
15108-4000
US

IV. Provider business mailing address

134 LONG VALLEY DRIVE EXT
CORAOPOLIS PA
15108-4000
US

V. Phone/Fax

Practice location:
  • Phone: 412-992-1581
  • Fax:
Mailing address:
  • Phone: 412-992-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015902
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: