Provider Demographics
NPI:1346993870
Name:BOUCOUVALAS, EVE LUCIA (LMT)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:LUCIA
Last Name:BOUCOUVALAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GLENHAVEN CIR E
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2222
Mailing Address - Country:US
Mailing Address - Phone:207-300-7733
Mailing Address - Fax:
Practice Address - Street 1:13 MARCH FARM WAY UNIT C
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-6235
Practice Address - Country:US
Practice Address - Phone:603-380-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
MEMT6621174H00000X, 225700000X
ME3747P1801X
NH8088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant