Provider Demographics
NPI:1205582467
Name:PURDY, DESEREE MATISE (MS)
Entity type:Individual
Prefix:MISS
First Name:DESEREE
Middle Name:MATISE
Last Name:PURDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 BRANDENBURG WAY
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3244
Mailing Address - Country:US
Mailing Address - Phone:610-991-6543
Mailing Address - Fax:
Practice Address - Street 1:2305 BRANDENBURG WAY
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3244
Practice Address - Country:US
Practice Address - Phone:610-991-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)