Provider Demographics
NPI:1770804122
Name:BEAUCHAMPS, CECILY JENNETTE (HHA)
Entity type:Individual
Prefix:MISS
First Name:CECILY
Middle Name:JENNETTE
Last Name:BEAUCHAMPS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4029
Mailing Address - Country:US
Mailing Address - Phone:215-274-5777
Mailing Address - Fax:215-274-5647
Practice Address - Street 1:1300 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 203A
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4029
Practice Address - Country:US
Practice Address - Phone:215-274-5777
Practice Address - Fax:215-274-5647
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04060501172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker