Provider Demographics
NPI:1760733372
Name:BOUCHER, JACALYN CORRINE (CLINICIAN)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:CORRINE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SUMMER ST STE 135A
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5783
Mailing Address - Country:US
Mailing Address - Phone:978-870-9905
Mailing Address - Fax:978-268-5768
Practice Address - Street 1:250 COMMERCIAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1726
Practice Address - Country:US
Practice Address - Phone:508-752-4665
Practice Address - Fax:508-752-0947
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical