Provider Demographics
NPI:1669543823
Name:SOUCIE, THERESA JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JEAN
Last Name:SOUCIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1605
Mailing Address - Country:US
Mailing Address - Phone:508-997-9100
Mailing Address - Fax:508-993-5854
Practice Address - Street 1:270 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1605
Practice Address - Country:US
Practice Address - Phone:508-997-9100
Practice Address - Fax:508-993-5854
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MADC-2870111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37022OtherBLUE CROSS
MIY4570602OtherMEDICARE ACTIVE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
MAAA13010OtherHARVARD PILGRIM
MA3649556OtherAETNA
MA469514OtherTUFTS
MA44-00351OtherUNITED HEALTH CARE
MIY4570602OtherMEDICARE ACTIVE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)