Provider Demographics
NPI:1881806131
Name:BEUKEMA, STEPHANIE
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:BEUKEMA
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 1:3 CONCORD AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3627
Mailing Address - Country:US
Mailing Address - Phone:617-576-0854
Mailing Address - Fax:617-864-5548
Practice Address - Street 1:3 CONCORD AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3627
Practice Address - Country:US
Practice Address - Phone:617-576-0854
Practice Address - Fax:617-864-5548
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA380423OtherMAGELLAN ID
MAW05102OtherBCBS NATIONAL ID NUMBER