Basic Information
| Provider Information | |||||||||
| NPI: | 1487625083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUPLESSIS | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, PCNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015500040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089097799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DUDLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659167 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RNCNS21791 | RI | N | Nursing Service Providers | Registered Nurse | Case Management | 163WP0807X | RN21791 | RI | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 364SP0807X | PPNS0040 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent | 364SP0807X | RN166154 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | DD31513 | 05 | RI | MEDICAID |