Provider Demographics
NPI:1215574272
Name:BEAUVIL, JEFF JR
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BEAUVIL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66L VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4157
Mailing Address - Country:US
Mailing Address - Phone:857-389-4551
Mailing Address - Fax:
Practice Address - Street 1:66L VETERANS AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-4157
Practice Address - Country:US
Practice Address - Phone:857-389-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS33978788103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily