Provider Demographics
NPI:1417063975
Name:BECKER, PAUL GERARD
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GERARD
Last Name:BECKER
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 1:11545 LAUREL LAKE SQ
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6069
Mailing Address - Country:US
Mailing Address - Phone:703-591-1890
Mailing Address - Fax:
Practice Address - Street 1:11545 LAUREL LAKE SQ
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6069
Practice Address - Country:US
Practice Address - Phone:703-591-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional