Provider Demographics
NPI:1831113976
Name:BEAUCHAMP, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA DE DIEGO CALLE CANADA 1324
Mailing Address - Street 2:CENTRO SALUD MENTAL SAN PATRICIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-793-2790
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA DE DIEGO CALLE CANADA 1324
Practice Address - Street 2:CENTRO SALUD MENTAL SAN PATRICIO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-793-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR48011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6-2007Medicare ID - Type Unspecified