Provider Demographics
NPI:1780731315
Name:BECKER, JACQUELINE BLUMENFELD (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BLUMENFELD
Last Name:BECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TRUDY CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1127
Mailing Address - Country:US
Mailing Address - Phone:631-427-4260
Mailing Address - Fax:
Practice Address - Street 1:1 TRUDY CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1127
Practice Address - Country:US
Practice Address - Phone:917-887-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical