Provider Demographics
NPI:1386838274
Name:BECKER, KATHLEEN AMY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:AMY
Last Name:BECKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E BIG BEAVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1435
Mailing Address - Country:US
Mailing Address - Phone:248-817-6629
Mailing Address - Fax:248-817-6694
Practice Address - Street 1:700 E BIG BEAVER RD STE D
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1435
Practice Address - Country:US
Practice Address - Phone:248-817-6629
Practice Address - Fax:248-817-6694
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081186104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker