| Doctor Name: | YVETTE W BOUCARUT |
| NPI Number: | 1326105131 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 05116 |
| Business Practice Address: | 6201 Greenbelt Rd Suite U-4 Berwyn Heights, MD - 207402354 |
| Business Phone Number: | 3012200599 |
| Business Fax Number: | 3012200599 |
| Mailing Address: | 6201 Greenbelt Rd, Suite U-4 BERWYN HEIGHTS |
| State: | MD |
| Postal Code: | 207402354 |
| Phone Number: | 3012200599 |
| Fax Number: | 3012200599 |
| NPI Enumeration Date: | 01/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 05116 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |