Basic Information
| Provider Information | |||||||||
| NPI: | 1003908781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAUVAIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 BARBERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032540639 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VA CONNECTICUT HEALTHCARE SYSTEM (116B) | ||||||||
| Address2: | 950 CAMPBELL AVENUE | ||||||||
| City: | WEST HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039325711 | ||||||||
| FaxNumber: | 2039374951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 002320 | CT | X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 002320 | CT | X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.