Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1887 | PR |
NPI | 1083775910 |
---|---|
Provider Name | Brenda Lee Beauchamp |
First Address | Camuy, PR 00627 |
Second Address | Camuy, PR 00627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |