Basic Information
| Provider Information | |||||||||
| NPI: | 1497005151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUCHARD | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 LAKEWOODS DR | ||||||||
| Address2: | |||||||||
| City: | MERRIMAC | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018601227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817181226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 823 LAFAYETTE RD | ||||||||
| Address2: | |||||||||
| City: | SEABROOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038744215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037601942 | ||||||||
| FaxNumber: | 6037601949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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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 | 363LP0808X | RN2270622 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 068808-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.