Provider Demographics
NPI:1215004320
Name:BEAUDOIN, ROBERT P (MSW ACSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:MSW ACSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE STREET
Mailing Address - Street 2:SUITE 15
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5937
Mailing Address - Country:US
Mailing Address - Phone:978-688-7933
Mailing Address - Fax:978-688-7933
Practice Address - Street 1:575 TURNPIKE STREET
Practice Address - Street 2:SUITE 15
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5937
Practice Address - Country:US
Practice Address - Phone:978-688-7933
Practice Address - Fax:978-688-7933
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022191041C0700X
NH41041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
003266OtherVALUE OPTIONS
MAP01872OtherBCBSMA
183346OtherPRIVATE HEALTHCARE SYSTEM
183346OtherPRIVATE HEALTHCARE SYSTEM