Provider Demographics
NPI:1073007415
Name:SOUZA, EDIE M (BEHAVIORAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:M
Last Name:SOUZA
Suffix:
Gender:F
Credentials:BEHAVIORAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 WARNER AVE # 339
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:808-273-4292
Mailing Address - Fax:888-293-3374
Practice Address - Street 1:2752 WOODLAWN DR STE 5-202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1855
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:888-293-3374
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician