Provider Demographics
NPI:1205160934
Name:POIRIER, GERALD E (MA LLP)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:E
Last Name:POIRIER
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 SUNBURST AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1040
Mailing Address - Country:US
Mailing Address - Phone:586-758-1084
Mailing Address - Fax:
Practice Address - Street 1:11022 SUNBURST AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1040
Practice Address - Country:US
Practice Address - Phone:586-758-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006364103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist