=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881570851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN BOUCHER MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 442 WILBUR AVE
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02777-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-322-1386
-----------------------------------------------------
Fax | 508-814-7153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1278 GAR HWY UNIT 501
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02777-7722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-322-1386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW2120988
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------