Doctor Name: | MRS. LAURA ANNE BOUCHER-POTTER |
NPI Number: | 1477694719 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | ISW01716 |
Business Practice Address: | 420 Fruit Hill Ave N Providence, RI - 029112626 |
Business Phone Number: | 4013533900 |
Business Fax Number: | 4017843549 |
Mailing Address: | 124 Oakland Ave, CRANSTON |
State: | RI |
Postal Code: | 02910 |
Phone Number: | 4012702606 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 04/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW01716 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |