Provider Demographics
NPI:1730828302
Name:SOARES, JOAO J
Entity type:Individual
Prefix:
First Name:JOAO
Middle Name:J
Last Name:SOARES
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 1:655 N MAIN ST # 2
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1432
Mailing Address - Country:US
Mailing Address - Phone:401-369-1221
Mailing Address - Fax:
Practice Address - Street 1:630 LINDSEY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1126
Practice Address - Country:US
Practice Address - Phone:781-540-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health