Organization
SOUL-FULL PRESENCE LLC
Active
Organization
SOUL-FULL PRESENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA L. L. DESROSIERS PSY.D. (CLINICAL PSYCHOLOGIST)
(443) 617-5152
Entity
Organization
Contact information
Practice address
101 W PARK PL, MIDDLETOWN, DE 19709-1324
(443) 617-5152
(302) 376-6145
Mailing address
105 NASHUA CT, BEAR, DE 19701-3324
(144) 361-7515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003096595
MEDICARE
DE
01
—
471526
MEDICARE
DE
Enumeration date
06/14/2021
Last updated
06/14/2021
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