Provider Demographics
NPI:1649714833
Name:DESROSIERS, FARRAH L
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:L
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE 137TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3762
Mailing Address - Country:US
Mailing Address - Phone:786-382-1701
Mailing Address - Fax:
Practice Address - Street 1:400 NE 137TH ST APT 310
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3762
Practice Address - Country:US
Practice Address - Phone:786-382-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst