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NPI Code Detail

MEDICARE: MS. KATHLEEN MARIE BOUDREAU LCSW

MEDICARE: MS. KATHLEEN MARIE BOUDREAU LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker002384CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831312826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHLEEN MARIE BOUDREAU LCSW
Provider Business Mailing Address
First Line : 698 ORANGE ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06511-2514
Country : US
Telephone Number : 203-562-1918
Fax Number : 203-772-0051
Provider Business Practice Location Address
First Line : 698 ORANGE ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06511-2514
Country : US
Telephone Number : 203-562-1918
Fax Number : 203-772-0051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/09/2007

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