Provider Demographics
NPI:1457037608
Name:BECK, MARTIN (CSW)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 SHELBY LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-8533
Mailing Address - Country:US
Mailing Address - Phone:646-831-2018
Mailing Address - Fax:
Practice Address - Street 1:535 W SECOND ST STE 207
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1268
Practice Address - Country:US
Practice Address - Phone:646-831-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2580541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical