Provider Demographics
NPI:1497910343
Name:BEAULIEU, MIMI (LPC, CCDP)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:LPC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1202
Mailing Address - Country:US
Mailing Address - Phone:203-298-8307
Mailing Address - Fax:
Practice Address - Street 1:195 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3171
Practice Address - Country:US
Practice Address - Phone:203-298-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional