Provider Demographics
NPI:1194496117
Name:BOUCHER, VANESSA VERLINGER (MSED)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:VERLINGER
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4910
Mailing Address - Country:US
Mailing Address - Phone:973-454-1363
Mailing Address - Fax:
Practice Address - Street 1:222 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4910
Practice Address - Country:US
Practice Address - Phone:973-454-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst