Provider Demographics
NPI:1093605362
Name:MOORE, BECKA L (LMSW, MASTER CASAC)
Entity type:Individual
Prefix:
First Name:BECKA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW, MASTER CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 CHENANGO ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1870
Mailing Address - Country:US
Mailing Address - Phone:607-725-1575
Mailing Address - Fax:
Practice Address - Street 1:783 CHENANGO ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1870
Practice Address - Country:US
Practice Address - Phone:607-725-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106607104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker