Provider Demographics
NPI:1558427013
Name:BECKER, CHRISTINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MARRETT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7936
Mailing Address - Country:US
Mailing Address - Phone:781-862-6170
Mailing Address - Fax:781-862-6170
Practice Address - Street 1:341 MARRETT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7936
Practice Address - Country:US
Practice Address - Phone:781-862-6170
Practice Address - Fax:781-862-6170
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4523736OtherAETNA
MA1028350OtherCIGNA
MAP01331OtherBLUE CROSS BLUE SHIELD
MA253533OtherMAGELLAN
MAP01331Medicare ID - Type Unspecified