Provider Demographics
NPI:1336116680
Name:WALLEN BEAUSEIGNEUR, CATHLEEN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:WALLEN BEAUSEIGNEUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10864 SW BLUE MESA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2138
Mailing Address - Country:US
Mailing Address - Phone:716-665-9805
Mailing Address - Fax:
Practice Address - Street 1:607 SW SAINT LUCIE CRES
Practice Address - Street 2:SUITE 101
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2851
Practice Address - Country:US
Practice Address - Phone:716-665-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW84801041C0700X
NYR0564501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical