Individual
MISS TRACY ANN DESRUISSEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
585 LINCOLN ST, WORCESTER, MA 01605-1906
(508) 831-0045
Mailing address
585 LINCOLN ST, WORCESTER, MA 01605-1906
(508) 831-0045
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306421
—
MA
05
—
1308785
—
MA
01
—
22220002001
BLUE CROSS
MA
01
—
M18684
BLUE CROSS
MA
Enumeration date
09/23/2009
Last updated
09/23/2009
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