Provider Demographics
NPI:1225472806
Name:BOUCHARD, ALEXANDRIA MADELINE (LICSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MADELINE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:MADELINE
Other - Last Name:BOUCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, MSW
Mailing Address - Street 1:2 WALL ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:
Practice Address - Street 1:9 BLODGET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3598
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 174400000X
NH22891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist