Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 002320 | CT |
N | 103TC0700X | Clinical Psychologist | 002320 | CT |
N | 103G00000X | Clinical Psychologist | 002320 | CT |
N | 103TC0700X | Clinical Psychologist | 002320 | CT |
NPI | 1003908781 |
---|---|
Provider Name | Dr. John Beauvais |
First Address | Southport, CT 06890 |
Second Address | West Haven, CT 06516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |