Provider Demographics
NPI:1851858401
Name:BOURSIQUOT, YVELANDE (LICSW)
Entity Type:Individual
Prefix:
First Name:YVELANDE
Middle Name:
Last Name:BOURSIQUOT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1960
Mailing Address - Country:US
Mailing Address - Phone:857-247-2272
Mailing Address - Fax:
Practice Address - Street 1:37 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1960
Practice Address - Country:US
Practice Address - Phone:857-247-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW03309101YM0800X, 104100000X
MA223293104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker