Provider Demographics
NPI:1609139724
Name:BECK, RENEE (MFT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 ALCATRAZ AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2726
Mailing Address - Country:US
Mailing Address - Phone:510-387-0341
Mailing Address - Fax:
Practice Address - Street 1:2711 ALCATRAZ AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2726
Practice Address - Country:US
Practice Address - Phone:510-387-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist