Provider Demographics
NPI:1588828628
Name:SOUSA, RACHAEL J (MA, MSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:J
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2720
Mailing Address - Country:US
Mailing Address - Phone:562-733-1147
Mailing Address - Fax:562-733-1157
Practice Address - Street 1:1301 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2720
Practice Address - Country:US
Practice Address - Phone:562-733-1147
Practice Address - Fax:562-733-1157
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker