Provider Demographics
NPI:1699735340
Name:WEEKS-BOUTILIER, CLARA MARGARET (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:MARGARET
Last Name:WEEKS-BOUTILIER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:MARGARET
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:35 HAWES ST
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1929
Mailing Address - Country:US
Mailing Address - Phone:508-993-1651
Mailing Address - Fax:508-996-9671
Practice Address - Street 1:35 HAWES ST
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1929
Practice Address - Country:US
Practice Address - Phone:508-993-1651
Practice Address - Fax:508-996-9671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
732870OtherTUFTS
MA102173OtherLICSW
P04206Medicare ID - Type Unspecified