Provider Demographics
NPI:1861766552
Name:BEAULIEU, CASSANDRA (BEH SHP SPEC)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:BEH SHP SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CANAL ST
Mailing Address - Street 2:210
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6082
Mailing Address - Country:US
Mailing Address - Phone:504-483-1985
Mailing Address - Fax:504-483-1984
Practice Address - Street 1:3801 CANAL ST
Practice Address - Street 2:210
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6082
Practice Address - Country:US
Practice Address - Phone:504-483-1985
Practice Address - Fax:504-483-1984
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6308OtherPROVIDER NUMBER