Provider Demographics
NPI:1497005151
Name:BOUCHARD, DANIELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAKEWOODS DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1227
Mailing Address - Country:US
Mailing Address - Phone:781-718-1226
Mailing Address - Fax:
Practice Address - Street 1:823 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4215
Practice Address - Country:US
Practice Address - Phone:603-760-1942
Practice Address - Fax:603-760-1949
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270622363LP0808X
NH068808-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health