Healthcare Provider Details

I. General information

NPI: 1881806131
Provider Name (Legal Business Name): DR. STEPHANIE BEUKEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CONCORD AVE SUITE #1
CAMBRIDGE MA
02138-3627
US

IV. Provider business mailing address

3 CONCORD AVE SUITE #1
CAMBRIDGE MA
02138-3627
US

V. Phone/Fax

Practice location:
  • Phone: 617-576-0854
  • Fax: 617-864-5548
Mailing address:
  • Phone: 617-576-0854
  • Fax: 617-864-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: