Provider Demographics
NPI:1902526080
Name:BEATON, AMELIA GRACE
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:GRACE
Last Name:BEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LANES END
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6160
Mailing Address - Country:US
Mailing Address - Phone:508-558-5274
Mailing Address - Fax:
Practice Address - Street 1:81 HOPE AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2212
Practice Address - Country:US
Practice Address - Phone:508-755-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMTN980829267OtherBLUE CROSS BLUE SHIELD