Provider Demographics
NPI:1356451710
Name:SOUZA, JOAN A (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:SOUZA
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND SQUARE
Mailing Address - Street 2:SUITE 232E
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4318
Mailing Address - Country:US
Mailing Address - Phone:401-273-4999
Mailing Address - Fax:401-273-9999
Practice Address - Street 1:1 RICHMOND SQUARE
Practice Address - Street 2:SUITE 232E
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4318
Practice Address - Country:US
Practice Address - Phone:401-273-4999
Practice Address - Fax:401-273-4999
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110419104100000X
RIISW01249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22359OtherBLUE CROSS
RI380354OtherMAGELLAN
RI6234979OtherUBH
MA380354OtherMAGELLAN
RI6234979OtherUBH