Provider Demographics
NPI:1982183059
Name:SOUSA, CRISTINA (LICSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SOUSA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WAVERLEY OAKS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8413
Mailing Address - Country:US
Mailing Address - Phone:617-972-5632
Mailing Address - Fax:
Practice Address - Street 1:307 WAVERLEY OAKS RD STE 205
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8413
Practice Address - Country:US
Practice Address - Phone:617-972-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1179521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical