Active NPI
Jacqueline De Cormier Beaulieu
- Social Worker
- West Roxbury, MA
National Provider Identifier
1568908002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 122139
- Practice address
- 1400 VFW Pkwy
Mail Stop a-122
West Roxbury, MA 02132-4927 - Phone
- (857) 203-5176
- NPI assigned
- Jan 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 222460 | MA | |
| Social Worker | 104100000X | 1165096 | MA | |
| Clinical Social Worker | 1041C0700X | 122139 | MA | |
| Clinical Social Worker | 1041C0700X | |||
| Social Worker | 104100000X | 122139 | MA | Primary |
Addresses
Primary practice location
1400 VFW Pkwy
Mail Stop a-122
West Roxbury, MA 02132-4927
Mailing address
1400 VFW Pkwy
Mail Stop a-122
West Roxbury, MA 02132-4927
Phone (857) 203-5176
Other names 1
- Jacqueline Noelle De Cormier
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1165096 | MA | MD | Social Worker |
| 122139 | MA | MD | Social Worker |
| 222460 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583366400000",
"number": "1568908002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 VFW PKWY",
"address_2": "MAIL STOP A-122",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324927",
"telephone_number": "857-203-5176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 VFW PKWY",
"address_2": "MAIL STOP A-122",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324927",
"telephone_number": "857-203-5176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAULIEU",
"first_name": "JACQUELINE",
"middle_name": "DE CORMIER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-09",
"last_updated": "2020-03-05",
"certification_date": "2020-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "222460",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "1165096",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "122139",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "122139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "DE CORMIER",
"middle_name": "NOELLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.