Jeremy M Boucher
Individual provider Active NPI Behavior Technician · Providence, RI
NPI 1366097115 · NPPES record last updated Aug 8, 2019
Key facts
- NPI
- 1366097115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 290 W Exchange Street
Suite 101
Providence, RI 02903 - Phone
- (401) 214-2330
- NPI assigned
- Aug 8, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
290 W Exchange Street
Suite 101
Providence, RI 02903
Mailing address
21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (818) 345-2345
Other providers in Providence, RI
- Charlene Beth Botelho
- Kristi Ann Botelho
- Nancy M Botelho
- Catherine Bothe
- Haylie Botts
- Robert Anthony Bouffard
- Brianna Leigh Boulanger
- Susannah Boulet
- Brittany Victoria Dalpe Bouley
- Kimberly Diane Boullard
All providers in Providence, RI · Behavior Technician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.