Active NPI
Deanna Boucher
- Clinical Social Worker
- Putnam, CT
National Provider Identifier
1982480950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 009778
- Practice address
- 554 Liberty Hwy Ste 3
Putnam, CT 06260-2728 - Phone
- (860) 634-0940
- NPI assigned
- Sep 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 009778 | CT | Primary |
Addresses
Primary practice location
554 Liberty Hwy Ste 3
Putnam, CT 06260-2728
Mailing address
PO Box 382
Putnam, CT 06260-0382
Phone (860) 634-0940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009778 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rooting Resilience, LLC | Clinical | Current | Accepting new patients |
Locations
554 Liberty Hwy
Ste 3
Putnam, CT 06260
Phone (860) 516-5672
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1982480950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 382",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062600382",
"telephone_number": "860-634-0940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 LIBERTY HWY STE 3",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062602728",
"telephone_number": "860-634-0940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "DEANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-06",
"last_updated": "2023-09-06",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "009778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.