Provider Demographics
NPI:1316492234
Name:DERISSE, VOLEILE
Entity type:Individual
Prefix:
First Name:VOLEILE
Middle Name:
Last Name:DERISSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HARDENBURGH RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5345
Mailing Address - Country:US
Mailing Address - Phone:954-234-1933
Mailing Address - Fax:
Practice Address - Street 1:116 HARDENBURGH RD
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5345
Practice Address - Country:US
Practice Address - Phone:954-234-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health