Provider Demographics
NPI:1609367721
Name:DESOETE, ASTRID CLEMENTINE
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:CLEMENTINE
Last Name:DESOETE
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 1:1221 MAIN ST STE 309
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5396
Mailing Address - Country:US
Mailing Address - Phone:413-313-3936
Mailing Address - Fax:
Practice Address - Street 1:1221 MAIN ST STE 309
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5396
Practice Address - Country:US
Practice Address - Phone:413-313-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor