Provider Demographics
NPI:1811168545
Name:BECKER, BRUCE ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ROBERT
Last Name:BECKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2016
Mailing Address - Country:US
Mailing Address - Phone:973-616-9623
Mailing Address - Fax:
Practice Address - Street 1:16 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1895
Practice Address - Country:US
Practice Address - Phone:973-835-6337
Practice Address - Fax:973-616-4688
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006767001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical