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NPI Code Detail

MEDICARE: DAVID BOULANGER

MEDICARE: DAVID BOULANGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCDP00696RI

General Provider Information

NPI Number : 1942725403
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BOULANGER
Provider Business Mailing Address
First Line : 985 PLAINFIELD ST
Second Line :
City : JOHNSTON
State : RI
Zip : 02919-6703
Country : US
Telephone Number : 401-946-0650
Fax Number :
Provider Business Practice Location Address
First Line : 985 PLAINFIELD ST
Second Line :
City : JOHNSTON
State : RI
Zip : 02919-6703
Country : US
Telephone Number : 401-946-0650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2017
Last Update Date : 07/21/2022

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