MEDICARE: MR. ROBERT P BEAUDOIN MSW ACSW LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102219	MA
2	1041C0700X	Clinical Social Worker	4	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003266	OTHER		VALUE OPTIONS
2	P01872	OTHER	MA	BCBSMA
3	183346	OTHER		PRIVATE HEALTHCARE SYSTEM

General Provider Information

NPI Number	:	1215004320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT P BEAUDOIN MSW ACSW LICSW

Provider Business Mailing Address
First Line	:	575 TURNPIKE STREET
Second Line	:	SUITE 15
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5937
Country	:	US
Telephone Number	:	978-688-7933
Fax Number	:	978-688-7933

Provider Business Practice Location Address
First Line	:	575 TURNPIKE STREET
Second Line	:	SUITE 15
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5937
Country	:	US
Telephone Number	:	978-688-7933
Fax Number	:	978-688-7933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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