MEDICARE: DR. MARIE-NATHALIE BEAUDOIN PSYCHOLOGIST

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	103TC0700X	Clinical Psychologist	PSY 15892	CA

General Provider Information

NPI Number	:	1447468558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE-NATHALIE BEAUDOIN PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	819 ANSHEN CT
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94086-8583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21760 STEVENS CREEK BLVD STE 102
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-1170
Country	:	US
Telephone Number	:	408-738-3343
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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