Provider Demographics
NPI:1396989349
Name:BOUCHER, LINDA SUSAN (BA, CADCII)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:BA, CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4449
Mailing Address - Country:US
Mailing Address - Phone:415-407-1512
Mailing Address - Fax:
Practice Address - Street 1:828 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2651
Practice Address - Country:US
Practice Address - Phone:415-407-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)