Provider Demographics
NPI:1285980466
Name:SOUCY, JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SOUCY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:SOUCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:5 UPLAND RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2771
Mailing Address - Country:US
Mailing Address - Phone:617-684-5689
Mailing Address - Fax:
Practice Address - Street 1:5 UPLAND RD STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2771
Practice Address - Country:US
Practice Address - Phone:617-684-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical