Provider Demographics
NPI:1134133549
Name:SOULIERE, SALLY (MSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SOULIERE
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 1:1 FATHER DEVALLES BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1511
Mailing Address - Country:US
Mailing Address - Phone:774-294-5055
Mailing Address - Fax:508-567-0407
Practice Address - Street 1:1 FATHER DEVALLES BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1511
Practice Address - Country:US
Practice Address - Phone:774-294-5055
Practice Address - Fax:508-567-0407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10268571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21446Medicare ID - Type Unspecified