Provider Demographics
NPI:1548619000
Name:BEAUDOIN-COLEGROVE, ROWEN
Entity Type:Individual
Prefix:
First Name:ROWEN
Middle Name:
Last Name:BEAUDOIN-COLEGROVE
Suffix:
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 1:108 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4902
Mailing Address - Country:US
Mailing Address - Phone:781-357-7808
Mailing Address - Fax:
Practice Address - Street 1:108 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-4902
Practice Address - Country:US
Practice Address - Phone:781-357-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program