Provider Demographics
NPI:1114081783
Name:BECKLEY, ANDREW (CADC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BECKLEY
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2247
Mailing Address - Country:US
Mailing Address - Phone:203-284-9499
Mailing Address - Fax:
Practice Address - Street 1:871 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3923
Practice Address - Country:US
Practice Address - Phone:203-787-2111
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA-1530-SA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO329553OtherVALU OPT CHN CT SAGA
CTB000698OtherDMHAS
CTCTGA000525OtherDMHAS