Christine Boucher
Individual provider Active NPI Professional Counselor · Broad Brook, CT
NPI 1619258993 · NPPES record last updated Dec 16, 2024
Key facts
- NPI
- 1619258993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 002338 (CT)
- Practice address
- 25 Folkstone Rd Apt B
Broad Brook, CT 06016-9434 - Phone
- (860) 530-0722
- NPI assigned
- Aug 31, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000964 | CT | MD | Professional Counselor |
| 002338 | CT | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 000964 | CT | |
| Professional Counselor | 101YP2500X | 002338 | CT | Yes |
Addresses
Primary practice location
25 Folkstone Rd Apt B
Broad Brook, CT 06016-9434
Mailing address
25 Folkstone Rd Apt B
Broad Brook, CT 06016-9434
Phone (860) 530-0722
Other providers in Broad Brook, CT
- Jessica Allard
- Tanya Brooks
- Margaret Wood Carchrie
- Guy Anthony Ciancio
- Community Health Resources
- Erin Gately
All providers in Broad Brook, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2024. 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.