Provider Demographics
NPI:1407947641
Name:BEAUDOIN, CAROL ANN (EDD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WHITE PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7621
Mailing Address - Country:US
Mailing Address - Phone:617-232-3603
Mailing Address - Fax:617-232-3603
Practice Address - Street 1:1101 BEACON ST # 7W
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-566-6560
Practice Address - Fax:617-232-3603
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist