Basic Information
| Provider Information | |||||||||
| NPI: | 1477630085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOUZA | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 JOHN DUGGAN RD | ||||||||
| Address2: | |||||||||
| City: | TIVERTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028781555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016255997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 438 E MAIN RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028427263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018418896 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 06/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW01000 | RI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ISW01968 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.