Provider Demographics
NPI:1982152096
Name:BEAUREGARD, KATHERINE (MA, LPC, MT-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:MA, LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DUCK CV
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3576
Mailing Address - Country:US
Mailing Address - Phone:860-338-1828
Mailing Address - Fax:
Practice Address - Street 1:27 DUCK CV
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3576
Practice Address - Country:US
Practice Address - Phone:860-338-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12576225A00000X
CT3803101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty