Provider Demographics
NPI:1205967429
Name:BOUCHARD, JEREMEE MICHELLE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JEREMEE
Middle Name:MICHELLE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 W EMPIRE AVE # 1050
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3434
Mailing Address - Country:US
Mailing Address - Phone:323-205-0730
Mailing Address - Fax:
Practice Address - Street 1:27955 SMYTH DR STE 101
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4037
Practice Address - Country:US
Practice Address - Phone:323-205-0730
Practice Address - Fax:818-366-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CALCS 246421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical