MEDICARE: NICOLE BECK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.014136	IL
2	1041C0700X	Clinical Social Worker	LCSW118793	CA

General Provider Information

NPI Number	:	1467081240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BECK LCSW

Provider Business Mailing Address
First Line	:	4638 5TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1445
Country	:	US
Telephone Number	:	312-709-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4638 5TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1445
Country	:	US
Telephone Number	:	312-709-9977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	07/31/2024

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Directions to “ NICOLE BECK LCSW” Practice Location

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