Healthcare Provider Details

I. General information

NPI: 1477314649
Provider Name (Legal Business Name): BENJAMIN BECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD BLDG 25
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

2250 LEESTOWN RD BLDG 25
LEXINGTON KY
40511-1052
US

V. Phone/Fax

Practice location:
  • Phone: 859-940-1526
  • Fax:
Mailing address:
  • Phone: 859-940-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259160
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: