Provider Demographics
NPI:1801832142
Name:DESESA-SMITH, DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:DESESA-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BUBBLING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2322
Mailing Address - Country:US
Mailing Address - Phone:508-668-0028
Mailing Address - Fax:
Practice Address - Street 1:15 BUBBLING BROOK RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2322
Practice Address - Country:US
Practice Address - Phone:508-668-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6816103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling