Provider Demographics
NPI:1053489617
Name:SOUZA, DEEDEE (MSW)
Entity Type:Individual
Prefix:
First Name:DEEDEE
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6014
Mailing Address - Country:US
Mailing Address - Phone:603-472-5248
Mailing Address - Fax:603-624-1884
Practice Address - Street 1:753 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3011
Practice Address - Country:US
Practice Address - Phone:603-668-0660
Practice Address - Fax:603-624-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 1871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001304Medicaid
NHRE1459Medicare ID - Type Unspecified