Provider Demographics
NPI:1700141512
Name:SOUZA, STEPHANIE NICHOLE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 COTTAGE WAY STE 16
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1226
Mailing Address - Country:US
Mailing Address - Phone:916-668-0626
Mailing Address - Fax:
Practice Address - Street 1:2640 SUTTERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1022
Practice Address - Country:US
Practice Address - Phone:916-668-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health