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General NPI Number Information
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NPI Number | 1306396494
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Entity Type | Individual
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Provider Name | KEVIN MARK BEAUDRY LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 200 SPRINGS RD
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City | BEDFORD
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State | MA
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Zip | 01730-1114
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Country | US
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Telephone | 781-654-1386
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Fax |
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Provider Business Mailing Address
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Address Line | 403 BELMONT ST
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City | WORCESTER
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State | MA
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Zip | 01604-1019
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Country | US
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Telephone | 134-342-2634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 122199
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License Number State | MA
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