Healthcare Provider Details

I. General information

NPI: 1043834740
Provider Name (Legal Business Name): KATLYNN BEAUMONT CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

IV. Provider business mailing address

5 COMMERCE DR - MODULAR
SKOWHEGAN ME
04976
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-8368
  • Fax:
Mailing address:
  • Phone: 207-474-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: