Active NPI
Jaclyn Sousa, PH.D.
- Clinical Psychologist
- Mt Pleasant, SC
National Provider Identifier
1396197356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1657
- Practice address
- 308 Bermuda Towne Row
Mt Pleasant, SC 29464-8230 - Phone
- (203) 518-1667
- NPI assigned
- Jul 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 021648-1 | NY | |
| Clinical Psychologist | 103TC0700X | 10929 | MA | |
| Clinical Psychologist | 103TC0700X | 1657 | SC | Primary |
Addresses
Primary practice location
308 Bermuda Towne Row
Mt Pleasant, SC 29464-8230
Mailing address
308 Bermuda Towne Row
Mt Pleasant, SC 29464-8230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1657 | SC | MD | Professional Counselor |
| 021648-1 | NY | MD | Psychologist |
| 10929 | MA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JLS PHD LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Mount Pleasant, SC
- NPI 1770173361
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634860800000",
"number": "1396197356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 BERMUDA TOWNE ROW",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294648230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 BERMUDA TOWNE ROW",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294648230",
"telephone_number": "203-518-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUSA",
"first_name": "JACLYN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-01",
"last_updated": "2021-10-22",
"certification_date": "2021-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "021648-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "10929",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "1657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.