Doctor Name: | DR. JESSICA LOIS DESROSIERS |
NPI Number: | 1003096595 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 3303 |
Business Practice Address: | 216 W Main St Middletown, DE - 19709 |
Business Phone Number: | 4436175152 |
Business Fax Number: | |
Mailing Address: | 105 Nashua Court, BEAR |
State: | DE |
Postal Code: | 197013324 |
Phone Number: | 4436175152 |
Fax Number: | |
NPI Enumeration Date: | 11/13/2007 |
NPI Last Update Date: | 02/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3303 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |