Provider Demographics
NPI:1154301323
Name:BECKER, PAUL F (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:BECKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23360 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5547
Mailing Address - Country:US
Mailing Address - Phone:216-595-3175
Mailing Address - Fax:216-595-3178
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5547
Practice Address - Country:US
Practice Address - Phone:216-595-3175
Practice Address - Fax:216-595-3178
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400542Medicaid
OH058987OtherVALUE OPTIONS
OH4084445OtherAETNA
OH000000113490OtherANTHEM BLUE SHIELD
OH680007112Medicare PIN
OH000000113490OtherANTHEM BLUE SHIELD