Healthcare Provider Details

I. General information

NPI: 1174657860
Provider Name (Legal Business Name): CHRISTIAN BAUCHARD LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WARE ST
WEST BROOKFIELD MA
01585
US

IV. Provider business mailing address

26 KOSTA ST
WORCESTER MA
01607
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-4451
  • Fax: 508-867-3555
Mailing address:
  • Phone: 508-757-7562
  • Fax: 508-867-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5933
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: