Healthcare Provider Details

I. General information

NPI: 1154354462
Provider Name (Legal Business Name): HENRY D. BECKWITH PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 NEUSE BLVD STE 5
NEW BERN NC
28562-2815
US

IV. Provider business mailing address

3304 TACK HOUSE RD
TRENT WOODS NC
28562-6646
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-0112
  • Fax: 252-634-9778
Mailing address:
  • Phone: 980-253-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: