=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508792029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADELINE HARENZA SOUSA MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2026
-----------------------------------------------------
Last Update Date | 06/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 928 JAYMOR RD STE 150
-----------------------------------------------------
City | SOUTHAMPTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18966-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-947-8654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 WASHINGTON ST APT 406
-----------------------------------------------------
City | CONSHOHOCKEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19428-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-401-3660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------