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NPI Code Detail

MEDICARE: MS. CAROL H BEAUDIN LMSW

MEDICARE: MS. CAROL H BEAUDIN LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker066035-1NY

General Provider Information

NPI Number : 1215109376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL H BEAUDIN LMSW
Provider Business Mailing Address
First Line : 352 GROS BLVD
Second Line :
City : HERKIMER
State : NY
Zip : 13350-1446
Country : US
Telephone Number : 315-867-2064
Fax Number :
Provider Business Practice Location Address
First Line : 352 GROS BLVD
Second Line :
City : HERKIMER
State : NY
Zip : 13350-1446
Country : US
Telephone Number : 315-867-2064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2008
Last Update Date : 09/12/2011

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