Provider Demographics
NPI:1326534918
Name:SOUSA-SANTOS, JESSICA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:SOUSA-SANTOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FEDERAL RD STE 312
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2419
Mailing Address - Country:US
Mailing Address - Phone:203-826-4262
Mailing Address - Fax:203-546-7082
Practice Address - Street 1:304 FEDERAL RD STE 312
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2419
Practice Address - Country:US
Practice Address - Phone:203-826-4262
Practice Address - Fax:203-546-7082
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical