Provider Demographics
NPI:1164869012
Name:BECKERMAN, AMANDA LINDSAY (MSED MSSPED)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LINDSAY
Last Name:BECKERMAN
Suffix:
Gender:F
Credentials:MSED MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 ALLON ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4701
Mailing Address - Country:US
Mailing Address - Phone:516-457-9183
Mailing Address - Fax:
Practice Address - Street 1:2911 ALLON ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4701
Practice Address - Country:US
Practice Address - Phone:516-457-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist