Provider Demographics
NPI:1841922614
Name:BEAULIEU, SARA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 BIRCH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4079
Mailing Address - Country:US
Mailing Address - Phone:207-215-2945
Mailing Address - Fax:
Practice Address - Street 1:501 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1503
Practice Address - Country:US
Practice Address - Phone:207-536-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health