Provider Demographics
NPI:1013018233
Name:BEAUDEAU, CHANTAL EUGENIE (MS, SPED, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:EUGENIE
Last Name:BEAUDEAU
Suffix:
Gender:F
Credentials:MS, SPED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3034
Mailing Address - Country:US
Mailing Address - Phone:516-435-8892
Mailing Address - Fax:516-775-0443
Practice Address - Street 1:1031 N 7TH ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3034
Practice Address - Country:US
Practice Address - Phone:516-435-8892
Practice Address - Fax:516-775-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726131961103TS0200X
NY264345081174400000X
NY003007-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist