Provider Demographics
NPI:1851855134
Name:BOUCHER, JESSI (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:CORRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 BURGOYNE ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1416
Mailing Address - Country:US
Mailing Address - Phone:518-366-8909
Mailing Address - Fax:
Practice Address - Street 1:12 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1734
Practice Address - Country:US
Practice Address - Phone:518-746-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099442-1104100000X
NY091920-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker