Provider Demographics
NPI:1053472860
Name:FOURNIER, SUZANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CTR
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-244-2405
Mailing Address - Fax:617-332-4306
Practice Address - Street 1:301 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:NEWTON CTR
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-244-2405
Practice Address - Fax:617-332-4306
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10186811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA003408OtherHARVARD PILGRAM PACIFICAR
6260192OtherUBH
MAP01229OtherBCBS
6260192OtherUBH