Healthcare Provider Details

I. General information

NPI: 1790268407
Provider Name (Legal Business Name): JACQUELINE DUCHARME SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 09/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BELMONT ST
WORCESTER MA
01604-1059
US

IV. Provider business mailing address

44 POND DR
WAYLAND MA
01778-4218
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3455
  • Fax:
Mailing address:
  • Phone: 508-843-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102676
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: