Provider Demographics
NPI:1811648835
Name:BEAUDOIN, SHELLEY M (LHMC)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:M
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1727
Mailing Address - Country:US
Mailing Address - Phone:479-366-9898
Mailing Address - Fax:
Practice Address - Street 1:2639 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1727
Practice Address - Country:US
Practice Address - Phone:479-366-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty