Provider Demographics
NPI:1568006278
Name:BOUCHER, CYNTHIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13118 226TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1732
Mailing Address - Country:US
Mailing Address - Phone:917-930-0054
Mailing Address - Fax:
Practice Address - Street 1:13118 226TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1732
Practice Address - Country:US
Practice Address - Phone:917-930-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0713631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical