Provider Demographics
NPI:1124420120
Name:BOUCHARD, RHIANNON MAIREAD (LICSW)
Entity type:Individual
Prefix:MS
First Name:RHIANNON
Middle Name:MAIREAD
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:RHIANNON
Other - Middle Name:MAIREAD
Other - Last Name:GOSHOW-SNOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-2032
Mailing Address - Country:US
Mailing Address - Phone:603-228-0547
Mailing Address - Fax:
Practice Address - Street 1:105 LOUDON RD BLDG 3
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5600
Practice Address - Country:US
Practice Address - Phone:603-228-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH32571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical