Provider Demographics
NPI:1518527571
Name:SOUSA OLIVEIRA, CLEZIANE
Entity Type:Individual
Prefix:
First Name:CLEZIANE
Middle Name:
Last Name:SOUSA OLIVEIRA
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 1:2232 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3446
Mailing Address - Country:US
Mailing Address - Phone:508-215-9688
Mailing Address - Fax:
Practice Address - Street 1:2232 AVALON DR
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3446
Practice Address - Country:US
Practice Address - Phone:508-215-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty