Provider Demographics
NPI:1285706341
Name:BOUDREAU, JEANNE CLAIRE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:CLAIRE
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:CLAIRE
Other - Last Name:CHIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 BRIDGE ST
Mailing Address - Street 2:THE SIMPSON BLOCK
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1268
Mailing Address - Country:US
Mailing Address - Phone:781-771-4212
Mailing Address - Fax:
Practice Address - Street 1:10 BRIDGE ST
Practice Address - Street 2:THE SIMPSON BLOCK
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1268
Practice Address - Country:US
Practice Address - Phone:781-771-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical