Provider Demographics
NPI:1457373995
Name:DUCHARME, COLLEEN KENDALL (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:KENDALL
Last Name:DUCHARME
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 1:70 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2637
Mailing Address - Country:US
Mailing Address - Phone:978-453-6800
Mailing Address - Fax:
Practice Address - Street 1:77 E. MERRIMACK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-453-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical