MEDICARE: MS. RENEE SUSAN BECRAFT LCSW

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	1041C0700X	Clinical Social Worker	17756	CA

General Provider Information

NPI Number	:	1881724797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE SUSAN BECRAFT LCSW

Provider Business Mailing Address
First Line	:	20811 PALOS VERDES DR N
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717
Country	:	US
Telephone Number	:	310-325-6542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3051
Country	:	US
Telephone Number	:	310-668-6311
Fax Number	:	310-668-3458

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/03/2021

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