Healthcare Provider Details

I. General information

NPI: 1689122160
Provider Name (Legal Business Name): BRIAN R. BECRAFT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

16632 NW 23RD ST APT. 14-104
PEMBROKE PINES FL
33028-1890
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 954-616-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 9662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: