Provider Demographics
NPI:1295296416
Name:DESOUZA, STEPHANIE (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BARCLAY ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:267-258-3974
Mailing Address - Fax:
Practice Address - Street 1:17 BARCLAY ST
Practice Address - Street 2:BUILDING A
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:267-258-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health