Provider Demographics
NPI:1427497882
Name:JEAN RICHARD LADOUCEUR
Entity type:Organization
Organization Name:JEAN RICHARD LADOUCEUR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LADOUCEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-593-8373
Mailing Address - Street 1:39 CHESTNUT COURT
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-593-8373
Mailing Address - Fax:
Practice Address - Street 1:61 ARROW RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1357
Practice Address - Country:US
Practice Address - Phone:860-593-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty