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General NPI Number Information
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NPI Number | 1114901212
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Entity Type | Individual
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Provider Name | TROI ALLISON BOULANGER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 836 MAIN ST
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City | WESTBROOK
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State | ME
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Zip | 04092-2861
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Country | US
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Telephone | 207-761-1160
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Fax | 207-761-1160
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Provider Business Mailing Address
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Address Line | 95 PARKER ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-4033
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Country | US
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Telephone | 978-225-2250
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Fax | 978-225-2251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LC6759
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License Number State | ME
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