Healthcare Provider Details

I. General information

NPI: 1679720908
Provider Name (Legal Business Name): MR. MATTHEW RICHARD DUSSAULT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N MAIN ST STE 205
FALL RIVER MA
02720-2972
US

IV. Provider business mailing address

3 EVERGREEN ST
FAIRHAVEN MA
02719-5406
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-1060
  • Fax:
Mailing address:
  • Phone: 508-994-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: