Provider Demographics
NPI:1629545454
Name:BEAULIEU, LAURIE ANN (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2402
Mailing Address - Country:US
Mailing Address - Phone:216-287-3926
Mailing Address - Fax:
Practice Address - Street 1:34305 SOLON RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2666
Practice Address - Country:US
Practice Address - Phone:440-349-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00081651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical