Provider Demographics
NPI:1376023119
Name:SOUERS, CARLA JOHNSON
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JOHNSON
Last Name:SOUERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1306
Mailing Address - Country:US
Mailing Address - Phone:508-485-0110
Mailing Address - Fax:
Practice Address - Street 1:35 VALLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1306
Practice Address - Country:US
Practice Address - Phone:508-485-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101918104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty