Individual
RICHARD J BOUCHARD JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
605 US ROUTE 1 STE 20, SCARBOROUGH, ME 04074-7675
(207) 650-6450
Mailing address
PO BOX 1933, PORTLAND, ME 04104-1933
(207) 650-6450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC4009
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037017
ANTHEM BC/BS PROVIDER NO.
ME
05
—
264990099
—
ME
Enumeration date
06/21/2006
Last updated
02/05/2025
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