Healthcare Provider Details

I. General information

NPI: 1578854154
Provider Name (Legal Business Name): MARVA BECKFORD LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARNARD LN OFFICE 312
BLOOMFIELD CT
06002-2452
US

IV. Provider business mailing address

25 DIVISION ST
MANCHESTER CT
06040-4928
US

V. Phone/Fax

Practice location:
  • Phone: 860-817-1529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006837
License Number StateCT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARVA BECKFORD
Title or Position: OWNER
Credential:
Phone: 860-817-1529