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General NPI Number Information
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NPI Number | 1154760700
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Entity Type | Individual
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Provider Name | RANDY P SOUCY LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 100 CAMPUS AVE STE A&B
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City | LEWISTON
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State | ME
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Zip | 04240
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Country | US
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Telephone | 207-755-3434
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Fax | 207-755-3474
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Provider Business Mailing Address
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Address Line | PO BOX 7291
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City | LEWISTON
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State | ME
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Zip | 04243-7291
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Country | US
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Telephone | 207-777-8950
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Fax | 207-777-8800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC14696
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License Number State | ME
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