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General NPI Number Information
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NPI Number | 1639928153
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Entity Type | Individual
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Provider Name | MICHELE ANN BEAULIEU
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Gender | Female
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 78 S MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4594
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Country | US
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Telephone | 802-775-2381
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 BELGO RD APT 1
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City | CASTLETON
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State | VT
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Zip | 05735-5602
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Country | US
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Telephone | 207-831-5095
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 8064708
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 8064708
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License Number State | VT
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