Provider Demographics
NPI:1821235045
Name:BECKER, EDWARD (LISW-S)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:216-464-1277
Mailing Address - Fax:216-464-9109
Practice Address - Street 1:23811 CHAGRIN BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5525
Practice Address - Country:US
Practice Address - Phone:216-464-1277
Practice Address - Fax:216-464-9109
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00000781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical