Provider Demographics
NPI:1558095018
Name:SOUSA, JULIE MARIE (MA)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:MARIE
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 COLUMBIA RD APT 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3728
Mailing Address - Country:US
Mailing Address - Phone:141-389-6818
Mailing Address - Fax:
Practice Address - Street 1:142 CANAL ST STE 142P
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4673
Practice Address - Country:US
Practice Address - Phone:978-548-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist