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General NPI Number Information
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NPI Number | 1740347822
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Entity Type | Individual
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Provider Name | MATTHEW BOUCHER LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 17 ASHTON PKWY STE 204
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City | CUMBERLAND
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State | RI
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Zip | 02864-4827
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Country | US
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Telephone | 14-354-9708
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Fax | 401-333-4692
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Provider Business Mailing Address
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Address Line | 17 ASHTON PKWY STE 204
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City | CUMBERLAND
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State | RI
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Zip | 02864-4827
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Country | US
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Telephone | 401-354-9708
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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 | ISW01967
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW01967
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License Number State | RI
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