Provider Demographics
NPI:1467501411
Name:COURNOYER, ROBERT JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEAN
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 WYMAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 WYMAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1519
Practice Address - Country:US
Practice Address - Phone:617-332-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical