Provider Demographics
NPI:1720531247
Name:BECKER, FAITH MAKRIS
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:MAKRIS
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SE 5TH AVE APT 1606
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2955
Mailing Address - Country:US
Mailing Address - Phone:480-907-9324
Mailing Address - Fax:
Practice Address - Street 1:500 E BROWARD BLVD STE 1710
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33394-3005
Practice Address - Country:US
Practice Address - Phone:480-907-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015362101YM0800X
FLMH17695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968875910OtherUNITED HEALTHCARE