Provider Demographics
NPI:1235534843
Name:BECK, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MANSFIELD RD UNIT 1255
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-3309
Mailing Address - Country:US
Mailing Address - Phone:860-486-4705
Mailing Address - Fax:860-486-9159
Practice Address - Street 1:337 MANSFIELD RD UNIT 1255
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-3309
Practice Address - Country:US
Practice Address - Phone:860-486-4705
Practice Address - Fax:860-486-9159
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5945363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health