Provider Demographics
NPI:1528275369
Name:POIRIER, ROBERT LEO (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEO
Last Name:POIRIER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 LACLEDE AVE
Mailing Address - Street 2:MARCHETTI TOWERS EAST
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2011
Mailing Address - Country:US
Mailing Address - Phone:314-977-2323
Mailing Address - Fax:314-977-7165
Practice Address - Street 1:3518 LACLEDE AVE
Practice Address - Street 2:MARCHETTI TOWERS EAST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2011
Practice Address - Country:US
Practice Address - Phone:314-977-2323
Practice Address - Fax:314-977-7165
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist