Healthcare Provider Details

I. General information

NPI: 1982128922
Provider Name (Legal Business Name): KENNETH S BECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

IV. Provider business mailing address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-6690
  • Fax: 513-354-6699
Mailing address:
  • Phone: 513-354-6690
  • Fax: 513-354-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.981408
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: