Provider Demographics
NPI:1699569947
Name:BEAUREGARD, RACHEL CELESTINE (LMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CELESTINE
Last Name:BEAUREGARD
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 73RD ST APT 12E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3062
Mailing Address - Country:US
Mailing Address - Phone:347-652-4062
Mailing Address - Fax:
Practice Address - Street 1:112 W 73RD ST APT 12E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3062
Practice Address - Country:US
Practice Address - Phone:347-652-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123592-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker