Provider Demographics
NPI:1093854903
Name:BOUCHER, NICOLE MARIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN STREET
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562
Mailing Address - Country:US
Mailing Address - Phone:508-885-0788
Mailing Address - Fax:508-885-1388
Practice Address - Street 1:185 MAIN STREET
Practice Address - Street 2:SUITE 22
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562
Practice Address - Country:US
Practice Address - Phone:508-885-0788
Practice Address - Fax:508-885-1388
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMH000004698CC101YM0800X
MA4698101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health