Provider Demographics
NPI:1588865356
Name:BECERRA, WILLIAM (MH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BECERRA
Suffix:
Gender:M
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10,000 PMB 300
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-887-8972
Mailing Address - Fax:787-277-9595
Practice Address - Street 1:THOMASVILLE PARK
Practice Address - Street 2:EDIF. 1 APT. 1104
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-887-8972
Practice Address - Fax:787-277-9595
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health