Provider Demographics
NPI:1467197459
Name:FOURNIER, ISLAIDE
Entity Type:Individual
Prefix:
First Name:ISLAIDE
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISLAIDE
Other - Middle Name:
Other - Last Name:FOURNIER GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25365 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4724
Mailing Address - Country:US
Mailing Address - Phone:786-486-6056
Mailing Address - Fax:
Practice Address - Street 1:12001 SW 128TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4665
Practice Address - Country:US
Practice Address - Phone:786-975-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker