Provider Demographics
NPI:1033139563
Name:DUCHARME, STANLEY H (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:H
Last Name:DUCHARME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 POND DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4218
Mailing Address - Country:US
Mailing Address - Phone:617-638-7358
Mailing Address - Fax:617-638-8960
Practice Address - Street 1:720 HARRISON AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2371
Practice Address - Country:US
Practice Address - Phone:617-638-7358
Practice Address - Fax:617-638-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2191103TA0400X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0506605Medicaid
MA0506605Medicaid