Provider Demographics
NPI:1689122160
Name:BECRAFT, BRIAN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:BECRAFT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16632 NW 23RD ST
Mailing Address - Street 2:APT. 14-104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1890
Mailing Address - Country:US
Mailing Address - Phone:954-616-7804
Mailing Address - Fax:
Practice Address - Street 1:450 N PARK RD STE 400
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6918
Practice Address - Country:US
Practice Address - Phone:954-925-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical