Healthcare Provider Details

I. General information

NPI: 1639080708
Provider Name (Legal Business Name): STEVEN DESROSIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NE RIDDELL RD STE 110
BREMERTON WA
98310-3005
US

IV. Provider business mailing address

3628 OAK BAY RD
PORT HADLOCK WA
98339-9730
US

V. Phone/Fax

Practice location:
  • Phone: 360-228-7246
  • Fax: 360-228-7247
Mailing address:
  • Phone: 360-228-7246
  • Fax: 360-228-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO70041048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: