Provider Demographics
NPI:1962987289
Name:BECERRA, MAGDALENA MERCEDES
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:MERCEDES
Last Name:BECERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 VAN BUREN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6033
Mailing Address - Country:US
Mailing Address - Phone:951-830-9037
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:212-203-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121004104100000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker