Provider Demographics
NPI:1619159563
Name:BECKER, STEPHANIE LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LINDA
Last Name:BECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 MARKHAM RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9663
Mailing Address - Country:US
Mailing Address - Phone:949-954-7202
Mailing Address - Fax:503-486-3365
Practice Address - Street 1:1669 MARKHAM RD
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9663
Practice Address - Country:US
Practice Address - Phone:949-954-7202
Practice Address - Fax:503-486-3365
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041C0700X
CALCSW 71967101YM0800X
OR7857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619159563Medicaid
OR500760436Medicaid