Provider Demographics
NPI:1629357751
Name:BECKER, JOANNE (CDN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5708
Mailing Address - Country:US
Mailing Address - Phone:518-847-8879
Mailing Address - Fax:
Practice Address - Street 1:12 KATHLEEN DR
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-5708
Practice Address - Country:US
Practice Address - Phone:518-384-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48003974133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist