MEDICARE: FARRAH L DESROSIERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1649714833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH L DESROSIERS

Provider Business Mailing Address
First Line	:	400 NE 137TH ST APT 310
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3762
Country	:	US
Telephone Number	:	786-382-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NE 137TH ST APT 310
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3762
Country	:	US
Telephone Number	:	786-382-1701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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