Provider Demographics
NPI:1427109917
Name:DUSSAULT, ALBERT (LICMHC)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:DUSSAULT
Suffix:
Gender:M
Credentials:LICMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5617
Mailing Address - Country:US
Mailing Address - Phone:401-726-6650
Mailing Address - Fax:
Practice Address - Street 1:11 BELMONT ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5617
Practice Address - Country:US
Practice Address - Phone:401-726-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI537211000OtherPRACTIONER