Individual
JONATHAN C BEAZLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
384 MERROW RD STE D, TOLLAND, CT 06084-3957
(860) 875-2578
Mailing address
384 MERROW RD STE D, TOLLAND, CT 06084-3957
(860) 875-2578
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000631
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410000631CT02
ANTHEM BLUE CROSS
CT
Enumeration date
05/17/2007
Last updated
10/09/2024
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