Provider Demographics
NPI:1003459231
Name:SOUCY, ALICIA LYN (PMHNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYN
Last Name:SOUCY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WALLAGRASS
Mailing Address - State:ME
Mailing Address - Zip Code:04781-3039
Mailing Address - Country:US
Mailing Address - Phone:207-231-0037
Mailing Address - Fax:207-800-1004
Practice Address - Street 1:45 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WALLAGRASS
Practice Address - State:ME
Practice Address - Zip Code:04781-3039
Practice Address - Country:US
Practice Address - Phone:207-231-0037
Practice Address - Fax:207-800-1004
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health