Provider Demographics
NPI:1457426728
Name:BECKER, KYRA ASTRID (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:KYRA
Middle Name:ASTRID
Last Name:BECKER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704
Mailing Address - Country:US
Mailing Address - Phone:732-747-2944
Mailing Address - Fax:732-747-2979
Practice Address - Street 1:623 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704
Practice Address - Country:US
Practice Address - Phone:732-747-2944
Practice Address - Fax:732-747-2979
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05229200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
081876C9EMedicare UPIN
NJ735690Medicare ID - Type Unspecified