Provider Demographics
NPI:1831247949
Name:FIESTER, ALAN RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:FIESTER
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 1:1025 MILITARY TRL
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7040
Mailing Address - Country:US
Mailing Address - Phone:561-747-0200
Mailing Address - Fax:561-747-0295
Practice Address - Street 1:1025 MILITARY TRL
Practice Address - Street 2:SUITE 108
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-747-0200
Practice Address - Fax:561-747-0295
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2853103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist