Provider Demographics
NPI:1073689972
Name:BECKER, NADINE - (MA)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:-
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 BALBOA BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1519
Mailing Address - Country:US
Mailing Address - Phone:818-343-8686
Mailing Address - Fax:818-776-0312
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-343-8686
Practice Address - Fax:818-776-0312
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist