Healthcare Provider Details

I. General information

NPI: 1205936846
Provider Name (Legal Business Name): ELAINE JULIA BEAUDOIN LICSW,LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NORTHAMPTON ST
EASTHAMPTON MA
01027-1046
US

IV. Provider business mailing address

PO BOX 5700
BELFAST ME
04915-5700
US

V. Phone/Fax

Practice location:
  • Phone: 413-529-9300
  • Fax: 413-282-3880
Mailing address:
  • Phone: 866-431-4077
  • Fax: 413-774-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114345
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2208
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: