Healthcare Provider Details

I. General information

NPI: 1922915826
Provider Name (Legal Business Name): EMMA BEAULIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VICTORY RD
DORCHESTER MA
02122-3518
US

IV. Provider business mailing address

46 W NEWTON ST APT 10
BOSTON MA
02118-3845
US

V. Phone/Fax

Practice location:
  • Phone: 617-371-3010
  • Fax:
Mailing address:
  • Phone: 207-551-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: