Provider Demographics
NPI:1225797335
Name:DESOUSA, CRISTINA P (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:P
Last Name:DESOUSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5927
Mailing Address - Country:US
Mailing Address - Phone:203-778-2437
Mailing Address - Fax:203-885-7202
Practice Address - Street 1:16 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5927
Practice Address - Country:US
Practice Address - Phone:203-778-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT62441041C0700X
CT144341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical