Provider Demographics
NPI:1295963718
Name:BOUCHER, TAMMY MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 TRI CITY RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1337
Mailing Address - Country:US
Mailing Address - Phone:603-781-0250
Mailing Address - Fax:
Practice Address - Street 1:728 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3494
Practice Address - Country:US
Practice Address - Phone:603-742-5662
Practice Address - Fax:603-743-5106
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical