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General NPI Number Information
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NPI Number | 1902563711
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Entity Type | Individual
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Provider Name | JACQUELINE BEAUDRY
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 669 BEL AIR RD # 1083
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City | BEL AIR
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State | MD
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Zip | 21014-4306
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Country | US
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Telephone | 717-385-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 E WEST HWY APT 902
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City | BETHESDA
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State | MD
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Zip | 20814-4510
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Country | US
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Telephone | 717-385-5428
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06621
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License Number State | MD
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