Provider Demographics
NPI:1891834610
Name:KROPVELD-BOUCHER, JENNIFER LAURI (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAURI
Last Name:KROPVELD-BOUCHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DEFOREST ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1332
Mailing Address - Country:US
Mailing Address - Phone:617-361-1318
Mailing Address - Fax:
Practice Address - Street 1:58 DEFOREST ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1332
Practice Address - Country:US
Practice Address - Phone:617-361-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health