Becky E Black, RD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

36620 Issued in CA

Practice address

1772 Santa Cruz St
Laguna Beach, CA 92651-3352

Phone

(949) 290-4016

NPI assigned

Apr 21, 2010

Last updated

Jan 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1831416460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 SANTA CRUZ ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926513352",
            "telephone_number": "949-290-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 SANTA CRUZ ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926513352",
            "telephone_number": "949-290-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BECKY",
        "middle_name": "E",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-21",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "36620",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "709236",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NOT SURE HOW TO ANSWER THIS",
            "identifier": "1831416460",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.