Healthcare Provider Details

I. General information

NPI: 1689987257
Provider Name (Legal Business Name): JEAN RICHARD DESIR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UNION ST
WORCESTER MA
01608-1194
US

IV. Provider business mailing address

3222 ARBOR DR
SHREWSBURY MA
01545-6010
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-5400
  • Fax:
Mailing address:
  • Phone: 774-275-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier95273201
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK
# 2
Identifier1487863494
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMMIS
# 3
Identifier1894196
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMBHP
# 4
Identifier1081860
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON/BEACON
# 5
Identifier1894196
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: