MR. Jerry Thomas Souta Jr, LCSW

NPI #1831259829 in Melrose Park, Illinois

Provider Information

NPI Number: 1831259829
Entity Type: Individual
Name: MR. Jerry Thomas Souta Jr, LCSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LCSW
Enumeration Date: Dec 11, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1414 MAIN ST
City: Melrose Park
State: Illinois
ZIP Code: 60160-3902
Phone: (708) 681-0073

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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