Provider Demographics
NPI:1093463846
Name:SAINT SOUVER, DEANNA KAY (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:SAINT SOUVER
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MERRIAM RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1427
Mailing Address - Country:US
Mailing Address - Phone:508-320-5569
Mailing Address - Fax:
Practice Address - Street 1:111 MERRIAM RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1427
Practice Address - Country:US
Practice Address - Phone:508-320-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215783104100000X
FLSW116671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty