Provider Demographics
NPI:1275161317
Name:DESROSIERS PSYCHIATRIC LLC
Entity Type:Organization
Organization Name:DESROSIERS PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-PSYCH/MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-953-0736
Mailing Address - Street 1:23 BERNICE AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5010
Mailing Address - Country:US
Mailing Address - Phone:508-556-0385
Mailing Address - Fax:
Practice Address - Street 1:1 WELBY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1137
Practice Address - Country:US
Practice Address - Phone:508-556-0385
Practice Address - Fax:508-998-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty