Jacqueline Becker, LCSW
Individual provider Active NPI Specialist · Victor, NY
NPI 1134430838 · NPPES record last updated Nov 3, 2011
Key facts
- NPI
- 1134430838
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 053432-1 (NY)
- Practice address
- 590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744 - Phone
- (585) 924-7207
- Fax
- (585) 924-7049
- NPI assigned
- Jun 28, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053432-1 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western New York Speech-Language Pathology, OT, and PT Consultants | Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 053432-1 | NY | Yes |
Addresses
Primary practice location
590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744
Mailing address
590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744
Phone (585) 924-7207
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30-0213081 | Other | NY | TAX ID |
Other providers in Victor, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.