Provider Demographics
NPI:1164617742
Name:BOUCHER, CATHERINE WEISS (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:WEISS
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:306 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3102
Mailing Address - Country:US
Mailing Address - Phone:207-229-1847
Mailing Address - Fax:207-221-8689
Practice Address - Street 1:50 LYDIA LN
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2156
Practice Address - Country:US
Practice Address - Phone:207-221-8624
Practice Address - Fax:207-221-8689
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional