Provider Demographics
NPI:1427257286
Name:BECKWITH, REBECCA A (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 UNION ST STE C
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6100
Mailing Address - Country:US
Mailing Address - Phone:207-356-7992
Mailing Address - Fax:
Practice Address - Street 1:175 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6100
Practice Address - Country:US
Practice Address - Phone:207-356-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4168101YA0400X
MEMC111981041C0700X
MELC130561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME25564099OtherMAINE CARE