Healthcare Provider Details

I. General information

NPI: 1083921985
Provider Name (Legal Business Name): NEIL BECKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MAIN ST UNIT 201
OLD SAYBROOK CT
06475-2332
US

IV. Provider business mailing address

7362 WOODMONT CT
BOCA RATON FL
33434-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-247-5902
  • Fax:
Mailing address:
  • Phone: 203-247-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8701
License Number StateCT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: