Provider Demographics
NPI:1235282625
Name:GERSTEN, BECKI S (LCSW, CTS)
Entity Type:Individual
Prefix:MRS
First Name:BECKI
Middle Name:S
Last Name:GERSTEN
Suffix:
Gender:F
Credentials:LCSW, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PLAZA MIDDLESEX
Mailing Address - Street 2:P.O. BOX 357
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3468
Mailing Address - Country:US
Mailing Address - Phone:860-347-5556
Mailing Address - Fax:860-347-4748
Practice Address - Street 1:98 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-5556
Practice Address - Fax:860-347-4748
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0016391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
140001639CT01OtherBLUE CROSS
024747OtherVALUE OPTIONS
024747OtherVALUE OPTIONS