Healthcare Provider Details

I. General information

NPI: 1982670659
Provider Name (Legal Business Name): KATHLEEN H BECKER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E FULTON ST
GLOVERSVILLE NY
12078-3212
US

IV. Provider business mailing address

107 CIRCLE DR
JOHNSTOWN NY
12095-3791
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-3531
  • Fax:
Mailing address:
  • Phone: 518-762-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055936-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: