Provider Demographics
NPI:1427658483
Name:BECKER, NANCY JILL (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JILL
Last Name:BECKER
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 1:240 W 102ND ST APT 15
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4924
Mailing Address - Country:US
Mailing Address - Phone:212-749-0694
Mailing Address - Fax:212-316-6754
Practice Address - Street 1:240 W 102ND ST APT 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4924
Practice Address - Country:US
Practice Address - Phone:212-749-0694
Practice Address - Fax:212-316-6754
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0327551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical