Provider Demographics
NPI:1275967499
Name:DICHARD, LOUISA ELIZABETH (PMHCNS, BC)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:ELIZABETH
Last Name:DICHARD
Suffix:
Gender:F
Credentials:PMHCNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MAIN ST STE 22
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3964
Mailing Address - Country:US
Mailing Address - Phone:978-393-1884
Mailing Address - Fax:781-836-0676
Practice Address - Street 1:529 MAIN ST STE 21-22
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3964
Practice Address - Country:US
Practice Address - Phone:978-393-1884
Practice Address - Fax:781-836-0676
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN164761364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult