Provider Demographics
NPI:1669297693
Name:BEAULIEU, NATHAN MICHAEL
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1199
Mailing Address - Country:US
Mailing Address - Phone:413-737-9544
Mailing Address - Fax:413-737-4455
Practice Address - Street 1:1 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1199
Practice Address - Country:US
Practice Address - Phone:413-737-9544
Practice Address - Fax:413-737-4455
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker