MEDICARE: GRISSELLE BEAUCHAMP DRA

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	103TC0700X	Clinical Psychologist	6972	PR

General Provider Information

NPI Number	:	1679145742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISSELLE BEAUCHAMP DRA

Provider Business Mailing Address
First Line	:	MEDICAL CENTER PLAZA #740
Second Line	:	SUITE 213 AVE. HOSTOS
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1540
Country	:	US
Telephone Number	:	787-444-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER PLAZA #740
Second Line	:	SUITE 213 AVE. HOSTOS
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1540
Country	:	US
Telephone Number	:	787-444-1120
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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Directions to “ GRISSELLE BEAUCHAMP DRA” Practice Location

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