MEDICARE: ROGER BEAUDOIN LICSW

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	104100000X	Social Worker	365	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598894990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER BEAUDOIN LICSW

Provider Business Mailing Address
First Line	:	279 SHIRLEY HILL RD
Second Line	:
City	:	GOFFSTOWN
State	:	NH
Zip	:	03045-2344
Country	:	US
Telephone Number	:	603-497-2832
Fax Number	:

Provider Business Practice Location Address
First Line	:	279 SHIRLEY HILL RD
Second Line	:
City	:	GOFFSTOWN
State	:	NH
Zip	:	03045-2344
Country	:	US
Telephone Number	:	603-497-2832
Fax Number	:

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	07/08/2007

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