Provider Demographics
NPI:1821718271
Name:BOUTIN, CHERISE RENEE (MA, LCMHC)
Entity Type:Individual
Prefix:MISS
First Name:CHERISE
Middle Name:RENEE
Last Name:BOUTIN
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-1324
Mailing Address - Country:US
Mailing Address - Phone:802-355-4447
Mailing Address - Fax:802-376-1816
Practice Address - Street 1:4 S MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-7070
Practice Address - Country:US
Practice Address - Phone:802-355-4447
Practice Address - Fax:802-376-1816
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health