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NPI Code Detail

MEDICARE: MRS. MIRTA LILIANA TEDESCO SOUZA MS

MEDICARE: MRS. MIRTA LILIANA TEDESCO SOUZA MS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942246426
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRTA LILIANA TEDESCO SOUZA MS
Provider Business Mailing Address
First Line : 57 EDWARDS AVE
Second Line :
City : SWANSEA
State : MA
Zip : 02777-2106
Country : US
Telephone Number : 508-675-1806
Fax Number :
Provider Business Practice Location Address
First Line : 151 ROCK ST
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-3201
Country : US
Telephone Number : 508-678-7542
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MIRTA LILIANA TEDESCO SOUZA MS” Practice Location

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