Provider Demographics
NPI:1184221566
Name:BECKER, LAURA RENEE (MFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:BECKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1809
Mailing Address - Country:US
Mailing Address - Phone:203-501-0046
Mailing Address - Fax:
Practice Address - Street 1:12 ROCK RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1809
Practice Address - Country:US
Practice Address - Phone:203-501-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist