Individual
MR. CORBETT A. SOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
420 W USTICK RD, CALDWELL, ID 83605-6279
(208) 649-6048
(208) 906-2343
Mailing address
420 W USTICK RD, CALDWELL, ID 83605-6279
(208) 453-8915
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-34322
ID
Other
Enumeration date
12/10/2014
Last updated
07/14/2023
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