Provider Demographics
NPI:1447306915
Name:BECK, JEFFREY (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:#5E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-596-9170
Mailing Address - Fax:
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:#5E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-596-9170
Practice Address - Fax:718-596-9170
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist