Provider Demographics
NPI:1346574589
Name:BEAULIEU, AMY C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:C
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WOLF HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3020
Mailing Address - Country:US
Mailing Address - Phone:508-654-0006
Mailing Address - Fax:860-736-2048
Practice Address - Street 1:3 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1468
Practice Address - Country:US
Practice Address - Phone:508-654-0006
Practice Address - Fax:860-736-2048
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002968103TC0700X
RIPS01136103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical