Mimi Beaulieu, LPC, CCDP
Individual provider Active NPI Professional Counselor · Cheshire, CT
NPI 1497910343 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1497910343
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 001709 (CT)
- Practice address
- 195 S Main St
Cheshire, CT 06410-3171 - Phone
- (203) 298-8307
- NPI assigned
- Jul 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250318000934 | CT | Practitioner - Mental Health Counselor | 1153843388 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001709 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Step Up Care PC LLC | Professional | Current |
Accepting new patients |
Locations
111 Westcott Rd
Danielson, CT 06239
Phone (860) 774-9540
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 001709 | CT | Yes |
Addresses
Primary practice location
195 S Main St
Cheshire, CT 06410-3171
Mailing address
83 Chesterfield Rd
East Lyme, CT 06333-1202
Phone (203) 298-8307
Other providers in Cheshire, CT
- Kathleen Denise Bartkus
- Alie E Bates
- Celina Bazaar
- Sarah Bazata
- Roger Beaudoin
- Kelsey Beckius
- Becoming You Center for Transformation
- Jason M Belejack
- Jessica M Bella
- Sara Beltran
All providers in Cheshire, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.