MEDICARE: DR. CHELSEA LYN SOUSA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	P.08500	OH

General Provider Information

NPI Number	:	1356023998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEA LYN SOUSA PSY.D.

Provider Business Mailing Address
First Line	:	12900 LAKE AVE APT 2002
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-1559
Country	:	US
Telephone Number	:	808-375-8087
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 LAKE AVE APT 2002
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-1559
Country	:	US
Telephone Number	:	808-375-8087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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