Provider Demographics
NPI:1609664333
Name:BEAUREGARD, CAROLINE ISABELLE (RBT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ISABELLE
Last Name:BEAUREGARD
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 WELLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-8431
Mailing Address - Country:US
Mailing Address - Phone:704-621-5078
Mailing Address - Fax:
Practice Address - Street 1:1705 WELLINGTON LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026-8431
Practice Address - Country:US
Practice Address - Phone:704-621-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician