Provider Demographics
NPI:1841380631
Name:BOUDREAUX, ERIN LEE (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEE
Other - Last Name:O'HEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:56 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1917
Mailing Address - Country:US
Mailing Address - Phone:856-669-9954
Mailing Address - Fax:
Practice Address - Street 1:56 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:856-669-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical