Healthcare Provider Details

I. General information

NPI: 1679483465
Provider Name (Legal Business Name): CHARLOTTE ANNE BEAULIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BRAGDON LN STE 4
KENNEBUNK ME
04043-7262
US

IV. Provider business mailing address

290 BAXTER BLVD APT D2
PORTLAND ME
04101-1634
US

V. Phone/Fax

Practice location:
  • Phone: 207-298-1914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26444
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: