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General NPI Number Information
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NPI Number | 1902381114
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Entity Type | Organization
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Legal Business Name | MARY BOUCHER LICSW
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 6 OLD ROCHESTER RD STE 102C
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City | DOVER
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State | NH
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Zip | 03820-2028
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Country | US
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Telephone | 603-828-2434
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Fax |
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Provider Business Mailing Address
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Address Line | 90 NOBLE ST
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City | SOMERSWORTH
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State | NH
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Zip | 03878-2628
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Country | US
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Telephone | 603-828-2434
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY BOUCHER
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Credential | LCSW
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Telephone | 603-828-2434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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