Provider Demographics
NPI:1194121848
Name:CELINE BOUCHARD
Entity type:Organization
Organization Name:CELINE BOUCHARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-802-2372
Mailing Address - Street 1:106 STRAUBE CENTER BLVD
Mailing Address - Street 2:F-111
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1449
Mailing Address - Country:US
Mailing Address - Phone:609-802-2372
Mailing Address - Fax:
Practice Address - Street 1:106 STRAUBE CENTER BLVD
Practice Address - Street 2:F-111
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1449
Practice Address - Country:US
Practice Address - Phone:609-802-2372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty