Provider Demographics
NPI:1821056375
Name:BECKER, SUZANNE R (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:BECKER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:R
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:518 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723
Mailing Address - Country:US
Mailing Address - Phone:970-441-0026
Mailing Address - Fax:970-842-4951
Practice Address - Street 1:518 CURTIS ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723
Practice Address - Country:US
Practice Address - Phone:970-441-0026
Practice Address - Fax:970-842-4951
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW9921691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76183831Medicaid
CO76183831Medicaid