Basic Information
| Provider Information | |||||||||
| NPI: | 1487874269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 BERKSHIRE RD | ||||||||
| Address2: | NEWTOWN YOUTH AND FAMILY SERVICES | ||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064821361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034268103 | ||||||||
| FaxNumber: | 2032704338 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 BERKSHIRE RD | ||||||||
| Address2: | NEWTOWN YOUTH AND FAMILY SERVICES | ||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064821361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034268103 | ||||||||
| FaxNumber: | 2032704338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 06/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 004125862 | 05 | CT | MEDICAID | ANC1319 | 01 | CT | FACILITY PROVIDER ID | OTHER |