Provider Demographics
NPI:1114084985
Name:BEAUDRY, SANDRA LEE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:MINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:1 JUNKINS AVE
Mailing Address - Street 2:#2
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4561
Mailing Address - Country:US
Mailing Address - Phone:603-433-3109
Mailing Address - Fax:
Practice Address - Street 1:1 JUNKINS AVE
Practice Address - Street 2:#2
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4561
Practice Address - Country:US
Practice Address - Phone:603-433-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010263Medicaid