Provider Demographics
NPI:1396188249
Name:BEAULIEU, LOUIS A JR
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:A
Last Name:BEAULIEU
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 1:30 FOLLY POND ROAD #23
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-473-2889
Mailing Address - Fax:
Practice Address - Street 1:30 FOLLY POND RD APT 23
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5381
Practice Address - Country:US
Practice Address - Phone:978-473-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANONEOtherNONE