Roger Gerard Dextradeur

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

116 Issued in MA

Practice address

22 Front St
Fall River, MA 02721-4302

Phone

(508) 676-1307

Fax

(508) 674-4493

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Habit Opco, LLC

  • Methadone Clinic
  • Springfield, MA
  • NPI 1023175072
  NPD (past)
• Habit Opco, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fitchburg, MA
  • NPI 1255034880
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972621134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 FRONT ST",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027214302",
            "telephone_number": "508-676-1307",
            "fax_number": "508-674-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 FRONT ST",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027214302",
            "telephone_number": "508-676-1307",
            "fax_number": "508-674-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEXTRADEUR",
        "first_name": "ROGER",
        "middle_name": "GERARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roxanne Desousa
• Vanessa Andrade Desousa, COTA/L
• Christopher Desroches
• Shekinah Desrosiers
• Devillers Pharmacy Inc.
• Babak Deyhimpanah, MD
• Jennifer Dias-Rezendes, LSW
• Lucia R Dias, B.A.
• Michael Daniel Dias
• Michaela Dibiase

• Addiction (Substance Use Disorder) Counselor in Fall River, MA
• Providers in Fall River, MA by specialty
• Addiction (Substance Use Disorder) Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.