Healthcare Provider Details

I. General information

NPI: 1811837040
Provider Name (Legal Business Name): JENNIFER SOUCAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SUMMER ST
PROVIDENCE RI
02903-4011
US

IV. Provider business mailing address

153 SUMMER ST
PROVIDENCE RI
02903-4011
US

V. Phone/Fax

Practice location:
  • Phone: 401-721-9294
  • Fax: 401-729-0010
Mailing address:
  • Phone: 401-721-9294
  • Fax: 401-729-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: