| Doctor Name: | MS. DAIL MARIE BOUCHARD |
| NPI Number: | 1679880165 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC-1, CADAC |
| License Number: | 477 |
| Business Practice Address: | 111 Edgartown Vineyard Haven Rd Vineyard Haven, MA - 025684036 |
| Business Phone Number: | 5086937900 |
| Business Fax Number: | 5086960401 |
| Mailing Address: | 111 Edgartown Vineyard Haven Rd, VINEYARD HAVEN |
| State: | MA |
| Postal Code: | 025684036 |
| Phone Number: | 5086937900 |
| Fax Number: | 5086960401 |
| NPI Enumeration Date: | 09/07/2010 |
| NPI Last Update Date: | 09/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 477 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |