Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3303 | NC |
Y | 103TC0700X | Clinical Psychologist | 3303 | NC |
NPI | 1003096595 |
---|---|
Provider Name | Dr. Jessica Lois Desrosiers |
First Address | Bear, DE 19701-3324 |
Second Address | Middletown, DE 19709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 03/02/2016 |