Provider Demographics
NPI:1972677128
Name:BOUCHER, SUZANNE M (MED LMHC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:M
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:BOUCHER-JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED LMHC
Mailing Address - Street 1:18 DELL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4122
Mailing Address - Country:US
Mailing Address - Phone:617-926-3600
Mailing Address - Fax:617-924-1027
Practice Address - Street 1:127 N. BEACON ST.
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2712
Practice Address - Country:US
Practice Address - Phone:617-926-3600
Practice Address - Fax:617-924-1027
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health