Provider Demographics
NPI:1629166178
Name:BECK, DANIEL T (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:T
Last Name:BECK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PERRY ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6922
Mailing Address - Country:US
Mailing Address - Phone:617-232-0499
Mailing Address - Fax:
Practice Address - Street 1:19 PERRY ST
Practice Address - Street 2:APT. 3
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6922
Practice Address - Country:US
Practice Address - Phone:617-232-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW1929465-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASW1929465-1OtherSOCIAL WORK LICENSE