Provider Demographics
NPI:1689942161
Name:BEAUJON, EDITH CAROLY (LSW)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:CAROLY
Last Name:BEAUJON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:CAROLYN
Other - Last Name:BOGUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5205 ORDSALL PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6884
Mailing Address - Country:US
Mailing Address - Phone:917-378-0253
Mailing Address - Fax:
Practice Address - Street 1:5205 ORDSALL PL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6884
Practice Address - Country:US
Practice Address - Phone:917-378-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical