Individual
MR. CLYDE LOUIS BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1930 ROUTE 70 E, SUITE M 68, CHERRY HILL, NJ 08003-2150
(856) 751-0505
Mailing address
1930 ROUTE 70 E STE V105, CHERRY HILL, NJ 08003-4101
(856) 751-0505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC0133900009
NJ
Other
Enumeration date
06/08/2010
Last updated
12/05/2019
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