Provider Demographics
NPI:1205927308
Name:DESJARDINS, DAVID JOHN (LICSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:DESJARDINS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RICE CORNER CROSS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-1810
Mailing Address - Country:US
Mailing Address - Phone:508-867-8471
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:UNIT 200
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2058
Practice Address - Country:US
Practice Address - Phone:508-753-1260
Practice Address - Fax:508-831-9624
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical