Individual
DR. EDWIN D BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3817
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9227
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001663773
AMERIHEALTH PPO
—
01
—
2321722000
AMERIHEALTH HMO, KEYSTONE, IBC
—
01
—
3K6039
HEALTHNET
—
01
—
42304
UNIVERSITY HEALTHPLAN
—
01
—
476594000
MAGELLAN
—
01
—
7663465
AETNA
—
05
—
8879800
—
NJ
Enumeration date
10/11/2006
Last updated
01/25/2017
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