Provider Demographics
NPI:1164719878
Name:ROUSSEAU, BERLINE
Entity Type:Individual
Prefix:MISS
First Name:BERLINE
Middle Name:
Last Name:ROUSSEAU
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 1:339 HOVENDON AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1303
Mailing Address - Country:US
Mailing Address - Phone:508-857-2157
Mailing Address - Fax:
Practice Address - Street 1:339 HOVENDON AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1303
Practice Address - Country:US
Practice Address - Phone:508-857-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health