Provider Demographics
NPI:1265816581
Name:SOUSA, EUGENIA MARIA (CSAC, NO 1909-132)
Entity Type:Individual
Prefix:MRS
First Name:EUGENIA
Middle Name:MARIA
Last Name:SOUSA
Suffix:
Gender:F
Credentials:CSAC, NO 1909-132
Other - Prefix:MRS
Other - First Name:EUGENIA
Other - Middle Name:MARIA
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1646
Mailing Address - Country:US
Mailing Address - Phone:414-649-1924
Mailing Address - Fax:414-647-8602
Practice Address - Street 1:1111 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2301
Practice Address - Country:US
Practice Address - Phone:414-649-1924
Practice Address - Fax:414-647-8602
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICSAC 10909-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)