Provider Demographics
NPI:1154354462
Name:BECKWITH, HENRY D (PSYD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 TACK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-6646
Mailing Address - Country:US
Mailing Address - Phone:980-253-5323
Mailing Address - Fax:
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:STE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-636-0112
Practice Address - Fax:252-634-9778
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001007Medicaid
NC2821294OtherMEDICARE PTAN