Provider Demographics
NPI:1174892756
Name:SOUZA, LEONEL O
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:O
Last Name:SOUZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FOREST PINES DRIVE
Mailing Address - Street 2:P.O BOX 588
Mailing Address - City:EAST DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02641-0588
Mailing Address - Country:US
Mailing Address - Phone:508-385-8249
Mailing Address - Fax:
Practice Address - Street 1:130 FOREST PINES DRIVE
Practice Address - Street 2:
Practice Address - City:EAST DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02641-0588
Practice Address - Country:US
Practice Address - Phone:508-385-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)