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NPI Code Detail

MEDICARE: MRS. MARY BOBO BECKER M.S., LMFT

MEDICARE: MRS. MARY BOBO BECKER M.S., LMFT
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
1106H00000XMarriage & Family Therapist57602CA

General Provider Information

NPI Number : 1720264120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY BOBO BECKER M.S., LMFT
Provider Business Mailing Address
First Line : 287 LORTON AVE
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-4203
Country : US
Telephone Number : 408-759-4696
Fax Number :
Provider Business Practice Location Address
First Line : 287 LORTON AVE
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-4203
Country : US
Telephone Number : 408-759-4696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2008
Last Update Date : 06/25/2020

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