Provider Demographics
NPI:1801171285
Name:DESROCHES, ALYSSA SUZANNE (MSW, LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SUZANNE
Last Name:DESROCHES
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:SUZANNE
Other - Last Name:DESROCHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:832 BROADWAY
Mailing Address - Street 2:APT 4
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3027
Mailing Address - Country:US
Mailing Address - Phone:413-885-8155
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST
Practice Address - Street 2:SUITE J
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical