Provider Demographics
NPI:1811076128
Name:DUSSAULT, ADRIENNE (LICSW)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:DUSSAULT
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Gender:F
Credentials:LICSW
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3 DUNDEE PARK DR
Mailing Address - Street 2:GENERAL PSYCHOLOGICAL ASSOCIATES STE 203
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3723
Mailing Address - Country:US
Mailing Address - Phone:978-475-3590
Mailing Address - Fax:978-475-7620
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:GENERAL PSYCHOLOGICAL ASSOCIATES STE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3723
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:978-475-7620
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1134271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical