Provider Demographics
NPI:1902381114
Name:MARY BOUCHER LICSW
Entity Type:Organization
Organization Name:MARY BOUCHER LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-828-2434
Mailing Address - Street 1:90 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-2628
Mailing Address - Country:US
Mailing Address - Phone:603-828-2434
Mailing Address - Fax:
Practice Address - Street 1:6 OLD ROCHESTER RD STE 102C
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2028
Practice Address - Country:US
Practice Address - Phone:603-828-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health