Individual
MATTHEW IAN BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
128 LAKESIDE AVE STE 260, BURLINGTON, VT 05401-5911
(802) 657-7087
(802) 657-7078
Mailing address
128 LAKESIDE AVE STE 260, BURLINGTON, VT 05401-5911
(802) 657-7090
(802) 657-7078
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0134397
VT
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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