Provider Demographics
NPI:1336764943
Name:BOUCHARD, CAITLIN (LMHC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N QUIDNESSETT RD
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1511
Mailing Address - Country:US
Mailing Address - Phone:401-465-1426
Mailing Address - Fax:
Practice Address - Street 1:40 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3031
Practice Address - Country:US
Practice Address - Phone:401-465-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health