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General NPI Number Information
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NPI Number | 1093572679
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Entity Type | Organization
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Legal Business Name | BEAUREGARD CREATIVE ARTS THERAPY PLLC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 225 BROADWAY STE 2130
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City | NEW YORK
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State | NY
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Zip | 10007-3733
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Country | US
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Telephone | 917-204-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 135 COFFEY ST APT 206C
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City | BROOKLYN
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State | NY
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Zip | 11231-1055
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Country | US
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Telephone | 917-204-2846
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Fax |
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Authorized Official
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Title or Position | FOUNDER/SOLE MEMBER
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Name | MARK BEAUREGARD
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Credential | RDT/BCT, LCAT
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Telephone | 917-204-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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