Provider Demographics
NPI:1851328470
Name:DURHAM-FLINT, BECKY TAYLOR (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:TAYLOR
Last Name:DURHAM-FLINT
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S RIVERSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4365
Mailing Address - Country:US
Mailing Address - Phone:321-733-2299
Mailing Address - Fax:321-733-7515
Practice Address - Street 1:105 S RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4365
Practice Address - Country:US
Practice Address - Phone:321-733-2299
Practice Address - Fax:321-733-7515
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3348Medicare UPIN