Healthcare Provider Details

I. General information

NPI: 1962829069
Provider Name (Legal Business Name): TARA THERESA BECKMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 TUOLUMNE ST
VALLEJO CA
94590-4641
US

IV. Provider business mailing address

22158 N 6TH ST
CASTRO VALLEY CA
94546-7039
US

V. Phone/Fax

Practice location:
  • Phone: 707-648-8121
  • Fax: 707-648-8129
Mailing address:
  • Phone: 510-517-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: