Provider Demographics
NPI:1962784470
Name:SOUSA, LAUREN (LICSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SOUSA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST STE 123
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1838
Mailing Address - Country:US
Mailing Address - Phone:978-820-2265
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST STE 123
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1838
Practice Address - Country:US
Practice Address - Phone:978-820-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical