Individual
MARIO ANTONIO SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3102 E HIGHLAND AVE, PATTON, CA 92369-7813
(909) 425-7000
Mailing address
3404 SANTA CARLOTTA ST, LA CRESCENTA, CA 91214-1158
(818) 395-0331
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TF0200X
Forensic Psychologist
Primary
D6738240
CA
Other
Enumeration date
06/15/2013
Last updated
03/18/2024
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