Basic Information
| Provider Information | |||||||||
| NPI: | 1477927010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOHER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | BOOHER | ||||||||
| OtherFirstName: | MEGAN | ||||||||
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| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 68 CANONCHET AVE | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028882934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018418841 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 JOHN CLARKE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018418841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT00165 | RI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.