Provider Demographics
NPI:1639316573
Name:DESROSIERS, JANET
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:DESROSIERS
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 1:1787 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:LINNEUS
Mailing Address - State:ME
Mailing Address - Zip Code:04730-4650
Mailing Address - Country:US
Mailing Address - Phone:207-532-6011
Mailing Address - Fax:
Practice Address - Street 1:1787 BANGOR RD
Practice Address - Street 2:
Practice Address - City:LINNEUS
Practice Address - State:ME
Practice Address - Zip Code:04730-4650
Practice Address - Country:US
Practice Address - Phone:207-532-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME217350000Medicaid