Healthcare Provider Details

I. General information

NPI: 1356556203
Provider Name (Legal Business Name): HEIDI GAIL BECKER-SHARE MSW,ACSW,LSW,QCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 WASHINGTON AVE
OAKLYN NJ
08107-1517
US

IV. Provider business mailing address

328 WASHINGTON AVE
OAKLYN NJ
08107-1517
US

V. Phone/Fax

Practice location:
  • Phone: 856-287-5400
  • Fax:
Mailing address:
  • Phone: 856-287-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW003289E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: