Provider Demographics
NPI:1497793483
Name:DESROSIERS, PATRICIA LOUISE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LOUISE
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CROSSINGS BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5459
Mailing Address - Country:US
Mailing Address - Phone:270-315-8404
Mailing Address - Fax:
Practice Address - Street 1:2501 CROSSINGS BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5459
Practice Address - Country:US
Practice Address - Phone:270-315-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0026931Medicare PIN