Provider Demographics
NPI:1114445806
Name:DESRUISSEAUX, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DESRUISSEAUX
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:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03217-1150
Mailing Address - Country:US
Mailing Address - Phone:603-968-7452
Mailing Address - Fax:603-968-7455
Practice Address - Street 1:23 WEST ST # 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NH
Practice Address - Zip Code:03217-4219
Practice Address - Country:US
Practice Address - Phone:603-968-7452
Practice Address - Fax:603-968-7455
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-23-67527103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst