MEDICARE: JESSICA CATHERINE BECKER LMSW

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	104100000X	Social Worker	111106	NY

General Provider Information

NPI Number	:	1669183182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CATHERINE BECKER LMSW

Provider Business Mailing Address
First Line	:	345 CITY ISLAND AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1360
Country	:	US
Telephone Number	:	917-763-5313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5525 BROADWAY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5202
Country	:	US
Telephone Number	:	718-884-0279
Fax Number	:

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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