Basic Information
Provider Information
NPI: 1861118267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BECKER
FirstName: AMY
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 822 LIGHTFOOT DR
Address2:  
City: LANCASTER
State: PA
PostalCode: 176021256
CountryCode: US
TelephoneNumber: 6093203123
FaxNumber:  
Practice Location
Address1: 1400 BLACKHORSE HILL RD
Address2:  
City: COATESVILLE
State: PA
PostalCode: 193202040
CountryCode: US
TelephoneNumber: 6103847711
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/17/2022
LastUpdateDate: 10/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XB1-0011354DEY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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