Provider Demographics
NPI:1750068185
Name:FEQUIERE, GERARD CHARLES (PSY D)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:CHARLES
Last Name:FEQUIERE
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A3 CAMINO DE GARDENIAS, URB. ENRAMADA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-617-9838
Mailing Address - Fax:
Practice Address - Street 1:INSTITUTO SAN PABLO SUITE 506
Practice Address - Street 2:66 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-617-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical