Provider Demographics
NPI:1215821160
Name:SOUZA, JACQUELINE (BA, MSW, LSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:BA, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MARYLAND AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1737
Mailing Address - Country:US
Mailing Address - Phone:910-528-5443
Mailing Address - Fax:
Practice Address - Street 1:401 SHADY AVE STE B207
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4489
Practice Address - Country:US
Practice Address - Phone:412-823-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker