Elise J Boudreau

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LICSW950 Issued in NH

Practice address

183 Rockingham Road
Windham, NH 03087

Phone

(603) 434-9937

Fax

(603) 434-0427

NPI assigned

Oct 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Center for Southern New Hampshire Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Derry, NH
  • NPI 1003914466

  NH

  Medicare reassignment Care Compare group

Specialty

Clinical Social Worker

Education

Boston University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Health Center for Southern New Hampshire Inc 10 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104901149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "WINDHAM",
            "state": "NH",
            "postal_code": "03087",
            "telephone_number": "603-434-9937",
            "fax_number": "603-434-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 ROCKINGHAM ROAD",
            "city": "WINDHAM",
            "state": "NH",
            "postal_code": "03087",
            "telephone_number": "603-434-9937",
            "fax_number": "603-434-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "ELISE",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NH",
            "license": "LICSW950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue IV LLC
• Body and Mind Physical Therapy, LLC
• Lindsey Dawn Bokuniewicz, DPT
• Alexandra Donna Bondaruk, FNP-C
• Kayla Borman, PT, DPT, C/NDT, MBA
• Sarah Boulanger, LICSW
• Tammy J Branca, BA
• Nicholas Joseph Brigham, OT
• Samantha Broadhead, PH.D.
• Kimberly Ann Brown, PA-C

• All providers in Windham, NH
• Social Worker in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.