Healthcare Provider Details

I. General information

NPI: 1831011048
Provider Name (Legal Business Name): MARK BECKWITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHARLESTOWN RD
SPRINGFIELD VT
05156-4400
US

IV. Provider business mailing address

649 BUGBEE ST APT 25
WHITE RIVER JUNCTION VT
05001-2911
US

V. Phone/Fax

Practice location:
  • Phone: 802-909-2601
  • Fax:
Mailing address:
  • Phone: 802-591-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: