MEDICARE: DR. LAUREN VICTORIA FOURNIER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY25149	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063648822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN VICTORIA FOURNIER PSY.D.

Provider Business Mailing Address
First Line	:	362 TERMINO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2837
Country	:	US
Telephone Number	:	310-502-0016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4647 LONG BEACH BLVD STE A4
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6977
Country	:	US
Telephone Number	:	310-502-0016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	01/02/2019

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