| Doctor Name: | MS. KATHLEEN M BOUCHER |
| NPI Number: | 1023191756 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW MSW |
| License Number: | 000296LCSW |
| Business Practice Address: | 1078 West Main St Waterbury, CT - 067082651 |
| Business Phone Number: | 2037538336 |
| Business Fax Number: | 2037537618 |
| Mailing Address: | 1078 West Main St, WATERBURY |
| State: | CT |
| Postal Code: | 067082651 |
| Phone Number: | 2037538336 |
| Fax Number: | 2037537618 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 000296LCSW |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |