Provider Demographics
NPI:1447929799
Name:BEAULIEU, LISA MARIE (MFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PECK RD STE 1202
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-726-8241
Mailing Address - Fax:
Practice Address - Street 1:896 BANTAM ROAD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-3204
Practice Address - Country:US
Practice Address - Phone:860-361-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist