Provider Demographics
NPI:1831953538
Name:SOUSA, LILIANE PAIVA
Entity type:Individual
Prefix:
First Name:LILIANE
Middle Name:PAIVA
Last Name:SOUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2118
Mailing Address - Country:US
Mailing Address - Phone:617-702-6258
Mailing Address - Fax:
Practice Address - Street 1:1035 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1057
Practice Address - Country:US
Practice Address - Phone:617-702-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker