Provider Demographics
NPI:1609883834
Name:SOUZA, CELESTE MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:MARIE
Last Name:SOUZA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 HANOVER ST.
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02112
Mailing Address - Country:US
Mailing Address - Phone:617-643-8000
Mailing Address - Fax:
Practice Address - Street 1:332 HANOVER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-1901
Practice Address - Country:US
Practice Address - Phone:617-643-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490110131041C0700X
MO20060158181041C0700X
MA0001203141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical