Provider Demographics
NPI:1598830689
Name:BECKETT, WILLIAM BYRON (MSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BYRON
Last Name:BECKETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COPELAND ST
Mailing Address - Street 2:#3
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4073
Mailing Address - Country:US
Mailing Address - Phone:617-471-3131
Mailing Address - Fax:
Practice Address - Street 1:250 COPELAND ST
Practice Address - Street 2:#3
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4073
Practice Address - Country:US
Practice Address - Phone:617-471-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003323000OtherMAGELLAN HS
MA1850318Medicaid
MAP01450OtherBCBS
MA1850318Medicare ID - Type Unspecified