Provider Demographics
NPI:1699309187
Name:DE SOUZA, DANIELA CRISTINA MACHADO
Entity type:Individual
Prefix:MISS
First Name:DANIELA
Middle Name:CRISTINA MACHADO
Last Name:DE SOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CENTRAL ST # 1
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1349
Mailing Address - Country:US
Mailing Address - Phone:774-778-6947
Mailing Address - Fax:
Practice Address - Street 1:7 CENTRAL ST # 1
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1349
Practice Address - Country:US
Practice Address - Phone:774-778-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA027307143OtherSEVENCORNERS