Provider Demographics
NPI:1770323438
Name:BECKLOFF, ANNA MARIELLA (BSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIELLA
Last Name:BECKLOFF
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MARIELLA
Other - Last Name:PORTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4950 CORNERSTONE NORTH BLVD UNIT 1412
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2369
Mailing Address - Country:US
Mailing Address - Phone:267-261-9400
Mailing Address - Fax:
Practice Address - Street 1:380 BELLBROOK AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3638
Practice Address - Country:US
Practice Address - Phone:937-376-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.24106931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical