Healthcare Provider Details

I. General information

NPI: 1841644762
Provider Name (Legal Business Name): BECC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 BENEFIT ST
PROVIDENCE RI
02903-2934
US

IV. Provider business mailing address

439 BENEFIT ST
PROVIDENCE RI
02903-2934
US

V. Phone/Fax

Practice location:
  • Phone: 401-262-0841
  • Fax: 401-489-7620
Mailing address:
  • Phone: 401-262-0841
  • Fax: 401-489-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01886
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01675
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLDN00665
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NEIL BERANBAUM
Title or Position: MANAGER
Credential:
Phone: 401-262-0841