Individual
TRACY L SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
263 STATE ST STE 9, BANGOR, ME 04401-5461
(207) 299-3463
(866) 283-5267
Mailing address
PO BOX 1763, BANGOR, ME 04402-1763
(207) 299-3463
(186) 628-3526
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC13597
ME
Other
Enumeration date
09/21/2010
Last updated
09/04/2019
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