Individual
MINDY A KNIGHT BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
225 COMMERCIAL ST STE 300, PORTLAND, ME 04101-6606
(207) 768-0039
(207) 761-0265
Mailing address
225 COMMERCIAL ST. SUITE 300, PORTLAND, ME 04102
(207) 768-0039
(207) 761-0265
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC12108
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264890099
—
ME
Enumeration date
06/11/2007
Last updated
02/20/2017
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