Provider Demographics
NPI:1659331130
Name:GUILBAULT, BEATRICE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:R
Last Name:GUILBAULT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TOWER OFFICE PARK
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2182
Mailing Address - Country:US
Mailing Address - Phone:781-932-1980
Mailing Address - Fax:781-932-1980
Practice Address - Street 1:10 TOWER OFFICE PARK
Practice Address - Street 2:SUITE 210
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2182
Practice Address - Country:US
Practice Address - Phone:781-932-1980
Practice Address - Fax:781-932-1980
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51401Medicare ID - Type Unspecified