Provider Demographics
NPI:1518476894
Name:BOUDREAU, HANNAH GILLAN (MHRT-C, CADC)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:GILLAN
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:MHRT-C, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5234
Mailing Address - Country:US
Mailing Address - Phone:207-941-1612
Mailing Address - Fax:207-941-1634
Practice Address - Street 1:98 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5234
Practice Address - Country:US
Practice Address - Phone:207-404-1612
Practice Address - Fax:207-941-1634
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)