Provider Demographics
NPI:1932626710
Name:BEAUBRUN, JEAN MARC (BSW, MSW)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:MARC
Last Name:BEAUBRUN
Suffix:
Gender:M
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1202
Mailing Address - Country:US
Mailing Address - Phone:267-271-0822
Mailing Address - Fax:610-461-0951
Practice Address - Street 1:352 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079
Practice Address - Country:US
Practice Address - Phone:267-271-0822
Practice Address - Fax:610-461-0951
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00000000000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAW232853049Medicaid