Healthcare Provider Details

I. General information

NPI: 1649096140
Provider Name (Legal Business Name): JENNIFER MCVEY BEAUTON A.O.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 HIGHLAND TER
MEXICO ME
04257-1803
US

IV. Provider business mailing address

159 HIGHLAND TER
MEXICO ME
04257-1803
US

V. Phone/Fax

Practice location:
  • Phone: 207-418-4452
  • Fax:
Mailing address:
  • Phone: 207-418-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: