Provider Demographics
NPI:1003096595
Name:DESROSIERS, JESSICA LOIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LOIS
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NASHUA COURT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3324
Mailing Address - Country:US
Mailing Address - Phone:443-617-5152
Mailing Address - Fax:
Practice Address - Street 1:216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709
Practice Address - Country:US
Practice Address - Phone:443-617-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical