Basic Information
Provider Information | |||||||||
NPI: | 1013235738 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEAUVOIR | ||||||||
FirstName: | SANDY | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW, MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CHRISTOPHE | ||||||||
OtherFirstName: | SANDY | ||||||||
OtherMiddleName: | C | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LICSW, MSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1000 JEFFERSON ST STE 2C | ||||||||
Address2: |   | ||||||||
City: | LYNCHBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 245041724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552847483 | ||||||||
FaxNumber: | 6178070958 | ||||||||
Practice Location | |||||||||
Address1: | 8 N MAIN ST STE 201 | ||||||||
Address2: |   | ||||||||
City: | ATTLEBORO | ||||||||
State: | MA | ||||||||
PostalCode: | 027032273 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552847483 | ||||||||
FaxNumber: | 6178070958 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2010 | ||||||||
LastUpdateDate: | 07/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 117050 | MA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.