Stepahnie Christine Boudreau

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12117 Issued in MD

Practice address

611 S Charles St
Baltimore, MD 21230-3801

Phone

(410) 328-2293

Fax

(410) 328-5895

NPI assigned

Aug 7, 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

Other names 1

• Stephanie Christine Lutz Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992714893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64277",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644277",
            "telephone_number": "410-328-7037",
            "fax_number": "410-328-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212303801",
            "telephone_number": "410-328-2293",
            "fax_number": "410-328-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "STEPAHNIE",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "12117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "LUTZ",
            "middle_name": "CHRISTINE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• David Boucher, AGNP-C
• Emily Boucher
• Henry R Boucher, MD
• Shirley Bouchet, RN
• Robert Stephen Boud, DO
• Nikulas Lagene Boudreaux
• Diana Bouhassira, MD
• Nyshea Bouknight-Smith
• Alexandria Boulden
• Travis S Bouldin

• Clinical Social Worker in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Social Worker in Maryland

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.