Provider Demographics
NPI:1295440352
Name:BEAUREGARD, SOPHIA MARION
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARION
Last Name:BEAUREGARD
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 1:18 GLACIER WAY
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-2262
Mailing Address - Country:US
Mailing Address - Phone:508-322-8255
Mailing Address - Fax:
Practice Address - Street 1:4 UNION AVE APT G2
Practice Address - Street 2:
Practice Address - City:ONSET
Practice Address - State:MA
Practice Address - Zip Code:02558-3044
Practice Address - Country:US
Practice Address - Phone:508-322-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician