Provider Demographics
NPI:1558095018
Name:SOUSA, JULIE MARIE (MA)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:MARIE
Last Name:SOUSA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7006
Mailing Address - Country:US
Mailing Address - Phone:413-896-8182
Mailing Address - Fax:
Practice Address - Street 1:142 CANAL ST STE 142P
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4673
Practice Address - Country:US
Practice Address - Phone:978-548-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10002017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health