MEDICARE: JULIE BOARDSEN-BEAN LPC

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
1	101YP2500X	Professional Counselor	001584	CT

General Provider Information

NPI Number	:	1518169119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE BOARDSEN-BEAN LPC

Provider Business Mailing Address
First Line	:	PO BOX 103
Second Line	:
City	:	WEST MYSTIC
State	:	CT
Zip	:	06388-0103
Country	:	US
Telephone Number	:	860-536-2145
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 MASONS ISLAND RD
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-2938
Country	:	US
Telephone Number	:	860-536-2145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/26/2009

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Directions to “ JULIE BOARDSEN-BEAN LPC” Practice Location

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