Provider Demographics
NPI:1992973549
Name:BECKWITH, BERNARD J (PSYD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N RIVER RD
Mailing Address - Street 2:CAMELOT DES PLAINES, QUIGLEY 100
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1214
Mailing Address - Country:US
Mailing Address - Phone:847-391-8000
Mailing Address - Fax:
Practice Address - Street 1:1150 N RIVER RD
Practice Address - Street 2:CAMELOT DES PLAINES, QUIGLEY 100
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1214
Practice Address - Country:US
Practice Address - Phone:847-391-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical