Provider Demographics
NPI:1083916621
Name:VANCE B BECKER INC A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:VANCE B BECKER INC A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-757-1113
Mailing Address - Street 1:1451 QUAIL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2742
Mailing Address - Country:US
Mailing Address - Phone:949-757-1113
Mailing Address - Fax:
Practice Address - Street 1:1451 QUAIL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2742
Practice Address - Country:US
Practice Address - Phone:949-757-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001695173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013912443OtherNPI
CA1013912443OtherNPI