Healthcare Provider Details

I. General information

NPI: 1033139563
Provider Name (Legal Business Name): STANLEY H. DUCHARME PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HARRISON AVE SUITE 606
BOSTON MA
02118-2371
US

IV. Provider business mailing address

44 POND DR
WAYLAND MA
01778-4218
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-7358
  • Fax: 617-638-8960
Mailing address:
  • Phone: 617-638-7358
  • Fax: 617-638-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2191
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2191
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: