Healthcare Provider Details

I. General information

NPI: 1205410156
Provider Name (Legal Business Name): BARRIE BECKER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ROUTE 130
FORESTDALE MA
02644-1434
US

IV. Provider business mailing address

55 ROUTE 130
FORESTDALE MA
02644-1434
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-5306
  • Fax:
Mailing address:
  • Phone: 508-477-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1121286
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: