Provider Demographics
NPI:1366507832
Name:BEAUCHAMP, ELIZABETH LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:BEAUCHAMP
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 1:17 RIVERWIND DR
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1223
Mailing Address - Country:US
Mailing Address - Phone:518-384-2039
Mailing Address - Fax:518-384-2039
Practice Address - Street 1:17 RIVERWIND DR
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1223
Practice Address - Country:US
Practice Address - Phone:518-384-2039
Practice Address - Fax:518-384-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012034-1103TC0700X
NH680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH680OtherPSYCHOLOGY LICENSE
NY01674166Medicaid
NY012034-1OtherPSYCHOLOGY REGISTRATION