Provider Demographics
NPI:1356852503
Name:BECK, JANYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANYCE
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PEAKS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04108-1188
Mailing Address - Country:US
Mailing Address - Phone:520-730-3108
Mailing Address - Fax:
Practice Address - Street 1:34 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PEAKS ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04108-1188
Practice Address - Country:US
Practice Address - Phone:520-730-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC139481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty