Provider Demographics
NPI:1699036442
Name:BECKENSTEIN, JONATHAN AVERIL (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:AVERIL
Last Name:BECKENSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BROADWAY STE 432
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6814
Mailing Address - Country:US
Mailing Address - Phone:212-420-9255
Mailing Address - Fax:
Practice Address - Street 1:799 BROADWAY STE 432
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6814
Practice Address - Country:US
Practice Address - Phone:212-420-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038081-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical