| Doctor Name: | MS. NICOLE MARIE BOUCHER |
| NPI Number: | 1093854903 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.H.C. |
| License Number: | MH000004698CC |
| Business Practice Address: | 185 Main Street Suite 22 Spencer, MA - 01562 |
| Business Phone Number: | 5088850788 |
| Business Fax Number: | 5088851388 |
| Mailing Address: | 185 Main Street, Suite 22 SPENCER |
| State: | MA |
| Postal Code: | 01562 |
| Phone Number: | 5088850788 |
| Fax Number: | 5088851388 |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 10/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH000004698CC |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |