Provider Demographics
NPI:1063781615
Name:SOUZA, THERESA M (PHD, MS,, TLLP)
Entity type:Individual
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First Name:THERESA
Middle Name:M
Last Name:SOUZA
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Gender:F
Credentials:PHD, MS,, TLLP
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Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-889-0732
Practice Address - Street 1:871 BALTIMORE PIKE
Practice Address - Street 2:UNIT 31
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-889-0732
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health