Provider Demographics
NPI:1508902115
Name:BECKER, CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TODD POND RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3808
Mailing Address - Country:US
Mailing Address - Phone:781-259-0921
Mailing Address - Fax:
Practice Address - Street 1:51 KONDAZIAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2830
Practice Address - Country:US
Practice Address - Phone:617-924-2606
Practice Address - Fax:617-924-5111
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical