Provider Demographics
NPI:1801231220
Name:FOURNIER, THAIS ALEJANDRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:THAIS
Middle Name:ALEJANDRA
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CALLE VILLAMIL
Mailing Address - Street 2:METRO PLAZA TOWERS APT. 1602
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2829
Mailing Address - Country:US
Mailing Address - Phone:787-529-5554
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172
Practice Address - Street 2:URBANIZACION TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-4968
Practice Address - Country:US
Practice Address - Phone:787-743-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical