Healthcare Provider Details

I. General information

NPI: 1053545426
Provider Name (Legal Business Name): BECKET ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 OAKLAND ROAD
BELGRADE ME
04917
US

IV. Provider business mailing address

633 NH ROUTE #10 P.O. BOX 325
ORFORD NH
03777
US

V. Phone/Fax

Practice location:
  • Phone: 207-634-2590
  • Fax: 207-634-2599
Mailing address:
  • Phone: 603-353-9102
  • Fax: 603-353-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY T WOLTER
Title or Position: PRESIDENT
Credential:
Phone: 603-353-9102