Provider Demographics
NPI:1720668569
Name:DEBORAH BECERRA CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:DEBORAH BECERRA CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-885-1099
Mailing Address - Street 1:348 HATFIELD ST APT C
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1550
Mailing Address - Country:US
Mailing Address - Phone:413-885-1099
Mailing Address - Fax:
Practice Address - Street 1:348 HATFIELD ST APT C
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1550
Practice Address - Country:US
Practice Address - Phone:413-885-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12212OtherLICENSED MENTAL HEALTH COUNSELOR