Provider Demographics
NPI:1073352050
Name:BOUCHER, SAMANTHA LYNN (MS)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6144
Mailing Address - Country:US
Mailing Address - Phone:781-307-0098
Mailing Address - Fax:
Practice Address - Street 1:790 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6144
Practice Address - Country:US
Practice Address - Phone:781-307-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health