Healthcare Provider Details

I. General information

NPI: 1649293945
Provider Name (Legal Business Name): ROBERT ROLAND FOURNIER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT ROLAND FOURNIER PH.D.

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MAIN ST
OSTERVILLE MA
02655-2049
US

IV. Provider business mailing address

116 SNAKE POND RD
FORESTDALE MA
02644-1522
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-1676
  • Fax:
Mailing address:
  • Phone: 508-477-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1018786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: