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General NPI Number Information
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NPI Number | 1295963718
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Entity Type | Individual
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Provider Name | TAMMY MARIE BOUCHER LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 728 CENTRAL AVE
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City | DOVER
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State | NH
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Zip | 03820-3494
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Country | US
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Telephone | 603-742-5662
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Fax | 603-743-5106
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Provider Business Mailing Address
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Address Line | 729 TRI CITY RD
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City | SOMERSWORTH
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State | NH
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Zip | 03878-1337
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Country | US
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Telephone | 603-781-0250
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1471
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License Number State | NH
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