Provider Demographics
NPI:1952531592
Name:BOURSIQUOT, MARIE URANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:URANIE
Last Name:BOURSIQUOT
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 1:2925 10TH AVE N
Mailing Address - Street 2:SUITE 301-C
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3000
Mailing Address - Country:US
Mailing Address - Phone:561-433-8123
Mailing Address - Fax:561-433-8011
Practice Address - Street 1:2925 10TH AVE N
Practice Address - Street 2:SUITE 301-C
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3000
Practice Address - Country:US
Practice Address - Phone:561-433-8123
Practice Address - Fax:561-433-8011
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6933103TB0200X, 103TC0700X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool