Provider Demographics
NPI:1649571464
Name:BEAUREGARD, CHRISTINA ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:BEAUREGARD
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GOODRICH AVE
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03940
Mailing Address - Country:US
Mailing Address - Phone:207-438-6670
Mailing Address - Fax:207-438-1062
Practice Address - Street 1:402 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03940
Practice Address - Country:US
Practice Address - Phone:207-438-6670
Practice Address - Fax:207-438-1062
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223261041C0700X
LA50401041C0700X
NCC0080501041C0700X
NH29841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12228998OtherCAQH