Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2191 | MA |
Y | 103G00000X | Clinical Psychologist | 2191 | MA |
Y | 103TC0700X | Clinical Psychologist | 2191 | MA |
N | 103TH0100X | Health Service | 2191 | MA |
NPI | 1033139563 |
---|---|
Provider Name | Dr. Stanley H. Ducharme |
First Address | Wayland, MA 01778-4218 |
Second Address | Boston, MA 02118-2371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 26/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0506605 | (05) | MA |