Healthcare Provider Details

I. General information

NPI: 1821895004
Provider Name (Legal Business Name): GRACE BOGDAN BEULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1142 MAPLE AVE APT 3
EVANSTON IL
60202-4216
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1000
  • Fax:
Mailing address:
  • Phone: 980-395-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: