Individual
THERESA A BEAUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
291 WATERMAN ST, PROVIDENCE, RI 02906-5130
(401) 274-9231
Mailing address
PO BOX 8879, CRANSTON, RI 02920-0879
(401) 572-3120
(401) 572-3351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00502
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036990
NEIGHBORHOOD HEALTH
—
01
—
2785
BLUECROSS BLUESHIELD
RI
01
—
298567000
MAGELLAN
—
01
—
408805
BLUECHIP
RI
01
—
6254399
UNITED HEALTH
—
05
—
TB63105
—
RI
Enumeration date
03/09/2007
Last updated
05/16/2011
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