Individual
DESIRAE BROUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1443 HARTFORD AVE, JOHNSTON, RI 02919-3224
(401) 273-8100
(401) 861-8696
Mailing address
1443 HARTFORD AVE, JOHNSTON, RI 02919-3224
(401) 273-8100
(401) 861-8696
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750723656
—
RI
05
—
DB98591
—
RI
Enumeration date
07/22/2013
Last updated
05/17/2016
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