Provider Demographics
NPI:1699378356
Name:BECKFORD, RAQUEL CELICIA (LMT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:CELICIA
Last Name:BECKFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 MERRICK BLVD APT 1H
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3049
Mailing Address - Country:US
Mailing Address - Phone:347-730-2604
Mailing Address - Fax:
Practice Address - Street 1:13320 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1458
Practice Address - Country:US
Practice Address - Phone:347-730-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty