MEDICARE: MARIA L BECKER HSPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20041739A	IN

General Provider Information

NPI Number	:	1497721542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA L BECKER HSPP

Provider Business Mailing Address
First Line	:	1159 E VICTORIA ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-1445
Country	:	US
Telephone Number	:	574-287-3137
Fax Number	:	574-287-5651

Provider Business Practice Location Address
First Line	:	310 N IRONWOOD DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2520
Country	:	US
Telephone Number	:	574-287-6333
Fax Number	:	574-287-5651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/19/2007

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