Provider Demographics
NPI:1881570851
Name:BOUCHER, SUSAN (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 GAR HWY UNIT 501
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-7722
Mailing Address - Country:US
Mailing Address - Phone:774-322-1386
Mailing Address - Fax:
Practice Address - Street 1:442 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-2406
Practice Address - Country:US
Practice Address - Phone:774-322-1386
Practice Address - Fax:508-814-7153
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW21209881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical