Healthcare Provider Details

I. General information

NPI: 1457835514
Provider Name (Legal Business Name): MONICA P BEAULIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CENTRAL AVENUE ATTN: LEWISTON MIDDLE SCHOOL BASED HEALTH CENTER
LEWISTON ME
04240-6031
US

IV. Provider business mailing address

PO BOX 95000 LBX 7650 ATTN: ST MARYS HEALTH SYSTEM PROVIDER ENROLLMENT
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-4180
  • Fax: 207-753-6419
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC17470
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: