Active NPI
Mary Petrosko Becker, PHD, LP
- Clinical Psychologist
- Richfield, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP6102
- Practice address
- 790 W 66TH St
Richfield, MN 55423-2203 - Phone
- (612) 873-6963
- Fax
- (612) 904-4259
- NPI assigned
- Aug 26, 2015
- Last updated
- Jun 17, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP6102 | MN | Primary |
Addresses
Primary practice location
790 W 66TH St
Richfield, MN 55423-2203
Mailing address
701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hennepin Healthcare System, Inc | Current | Accepting new patients | |
| Hennepin Healthcare System Inc | Current | Accepting new patients | |
| Hennepin Healthcare System, Inc | Past | Accepting new patients |
Locations
701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005
701 Park Ave
#350
Minneapolis, MN 55415
Phone (612) 873-5334
790 W 66th St
Richfield, MN 55423
Phone (612) 352-5810
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Hennepin County Medical Center
- Rehabilitation Hospital Unit
- Minneapolis, MN
- NPI 1033138136
-
dba HCMC Specialty Services Pharmacy
- Specialty Pharmacy
- Minneapolis, MN
- NPI 1619567625
-
dba Hennepin County Medical Center
- General Acute Care Hospital
- Minneapolis, MN
- NPI 1407897309
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718582400000",
"number": "1285001255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151623",
"telephone_number": "612-873-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 W 66TH ST",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554232203",
"telephone_number": "612-873-6963",
"fax_number": "612-904-4259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKER",
"first_name": "MARY",
"middle_name": "PETROSKO",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-26",
"last_updated": "2024-06-17",
"certification_date": "2024-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP6102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.