Provider Information for 1164092961
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BRIDGETTE BOUCHER LCSW, MS
Sex: Female
NPI: 1164092961
Last Updated: 2021-06-25
Certification Date: 2021-06-25
Certification Date: 2021-06-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1164092961 | ||||||||
| Enumeration Date | 2021-06-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2021 1ST AVE APT 4F NEW YORK, NY 10029-5091 United States Phone: 212-729-4549 | Fax: | ||||||||
| Primary Practice Address | 2021 1ST AVE APT 4F NEW YORK, NY 10029-5091 United States Phone: 212-729-4549 | Fax: | ||||||||
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