| Mary Boucher Licsw | |
|
6 Old Rochester Rd Ste 102c Dover NH 03820-2028 | |
| (603) 828-2434 | |
| Not Available |
| Full Name | Mary Boucher Licsw |
|---|---|
| Speciality | Clinic/Center |
| Location | 6 Old Rochester Rd Ste 102c, Dover, New Hampshire |
| Authorized Official Name and Position | Mary Boucher (OWNER) |
| Authorized Official Contact | 6038282434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Boucher Licsw 90 Noble St Somersworth NH 03878-2628 Ph: (603) 828-2434 | Mary Boucher Licsw 6 Old Rochester Rd Ste 102c Dover NH 03820-2028 Ph: (603) 828-2434 |
| NPI Number | 1902381114 |
|---|---|
| Provider Enumeration Date | 10/03/2018 |
| Last Update Date | 10/03/2018 |
| Medicare PECOS PAC ID | 2961746847 |
|---|---|
| Medicare Enrollment ID | O20181204000790 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902381114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Boucher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033648175 PECOS PAC ID: 7618234790 Enrollment ID: I20171130000257 |
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