Provider Demographics
NPI:1992869184
Name:BECK, MARY R (MA LLP LMSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:BECK
Suffix:
Gender:F
Credentials:MA LLP LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23442 WILSON
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1757
Mailing Address - Country:US
Mailing Address - Phone:313-561-2313
Mailing Address - Fax:313-821-1957
Practice Address - Street 1:15450 EAST JEFFERSON
Practice Address - Street 2:SUITE 120
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230
Practice Address - Country:US
Practice Address - Phone:313-821-0171
Practice Address - Fax:313-821-1957
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005077103TC1900X
MI6801062409104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker