MEDICARE: LAURA DUCHARME LSWA

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
1	104100000X	Social Worker	933282	MA

General Provider Information

NPI Number	:	1992307425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DUCHARME LSWA

Provider Business Mailing Address
First Line	:	1269 MAIN ST
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-3099
Country	:	US
Telephone Number	:	978-287-7951
Fax Number	:	978-287-7876

Provider Business Practice Location Address
First Line	:	35 FOREST RIDGE RD
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-3844
Country	:	US
Telephone Number	:	979-287-7800
Fax Number	:	978-287-7950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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