Provider Demographics
NPI:1053960740
Name:BEAUMONT, GIANFRANCO (MA, MFT 3314)
Entity type:Individual
Prefix:
First Name:GIANFRANCO
Middle Name:
Last Name:BEAUMONT
Suffix:
Gender:M
Credentials:MA, MFT 3314
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25876 THE OLD RD # 86
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1711
Mailing Address - Country:US
Mailing Address - Phone:818-647-2988
Mailing Address - Fax:
Practice Address - Street 1:1345 FENCE ROW DR # 1345
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-7006
Practice Address - Country:US
Practice Address - Phone:203-873-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3314106H00000X
CT27.002768-ASOC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist