Brenda Beauregard, LCDP
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Pawtucket, RI
NPI 1659409647 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1659409647
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LCDP345 (RI)
- Practice address
- 249 Roosevelt Ave
Pawtucket, RI 02860-2134 - Phone
- (401) 724-8400
- Fax
- (401) 365-1100
- NPI assigned
- Mar 1, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCDP345 | RI | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCDP345 | RI | Yes |
Addresses
Primary practice location
249 Roosevelt Ave
Pawtucket, RI 02860-2134
Mailing address
249 Roosevelt Ave
Pawtucket, RI 02860-2134
Phone (401) 724-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GH56996 | Medicaid | RI |
Other providers in Pawtucket, RI
- Carol L Baum-Gupta
- Michelle Bliss Bayles
- Jessica Bazar
- Peter E Baziotis
- Sarah Lynn Beaudet
- Tanya Jean Becker
- Ann Bedard
- Begin Again Counseling, LLC
- Gerard Arthur Belhumeur
- Joseph Bellucci III
All providers in Pawtucket, RI · Addiction (Substance Use Disorder) Counselor in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.