Healthcare Provider Details

I. General information

NPI: 1518681220
Provider Name (Legal Business Name): GARRICK BEAULIERE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date: 05/07/2024
Reactivation Date: 07/12/2024

III. Provider practice location address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-951-7950
  • Fax:
Mailing address:
  • Phone: 410-951-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00765300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: