Healthcare Provider Details

I. General information

NPI: 1689360992
Provider Name (Legal Business Name): MAEGAN OLIVIA BECK SUPERVISEE IN SW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 ELK HILL RD
GOOCHLAND VA
23063-3318
US

IV. Provider business mailing address

16765 BORDER RIDGE LN
MONTPELIER VA
23192-2065
US

V. Phone/Fax

Practice location:
  • Phone: 804-457-4866
  • Fax:
Mailing address:
  • Phone: 804-815-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: