Healthcare Provider Details

I. General information

NPI: 1962634493
Provider Name (Legal Business Name): CERISSA LEIGH DESROSIERS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 LAFAYETTE RD
SEABROOK NH
03874-4215
US

IV. Provider business mailing address

823 LAFAYETTE RD
SEABROOK NH
03874-4215
US

V. Phone/Fax

Practice location:
  • Phone: 603-760-1942
  • Fax: 603-760-1949
Mailing address:
  • Phone: 603-760-1942
  • Fax: 603-760-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: