Healthcare Provider Details

I. General information

NPI: 1528007614
Provider Name (Legal Business Name): SUZANNE BECKER, LCSW, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 CURTIS ST
BRUSH CO
80723-2512
US

IV. Provider business mailing address

306 CURTIS ST
BRUSH CO
80723-2512
US

V. Phone/Fax

Practice location:
  • Phone: 970-441-0026
  • Fax:
Mailing address:
  • Phone: 970-441-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUZANNE R BECKER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 970-441-0026