Healthcare Provider Details

I. General information

NPI: 1982152096
Provider Name (Legal Business Name): KATHERINE BEAUREGARD M.A., LPC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 DUCK CV
SOUTH WINDSOR CT
06074-3576
US

IV. Provider business mailing address

27 DUCK CV
SOUTH WINDSOR CT
06074-3576
US

V. Phone/Fax

Practice location:
  • Phone: 860-338-1828
  • Fax:
Mailing address:
  • Phone: 860-338-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3803
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12576
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: