Provider Demographics
NPI:1780758565
Name:SOUSSE, BERNARD JOSEPH (MA)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:JOSEPH
Last Name:SOUSSE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3328
Mailing Address - Country:US
Mailing Address - Phone:413-210-6979
Mailing Address - Fax:
Practice Address - Street 1:1727 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1919
Practice Address - Country:US
Practice Address - Phone:413-532-0926
Practice Address - Fax:413-532-0928
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health