Provider Demographics
NPI:1548316045
Name:DE SOUZA, CORALI
Entity type:Individual
Prefix:MRS
First Name:CORALI
Middle Name:
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 1:170 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6517
Mailing Address - Country:US
Mailing Address - Phone:508-397-5879
Mailing Address - Fax:508-620-2637
Practice Address - Street 1:118 UNION AVE STE 17
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8208
Practice Address - Country:US
Practice Address - Phone:508-397-5879
Practice Address - Fax:508-872-5521
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health