Provider Demographics
NPI:1821503871
Name:MADORE, ANGELA BOUCHARD (LICSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BOUCHARD
Last Name:MADORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1905
Mailing Address - Country:US
Mailing Address - Phone:617-470-3917
Mailing Address - Fax:
Practice Address - Street 1:1 APPLETON ST FL 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5223
Practice Address - Country:US
Practice Address - Phone:617-423-6300
Practice Address - Fax:617-423-6303
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical