Provider Demographics
NPI:1831604032
Name:BECERRA, ANA ISABEL (PSYD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:ISABEL
Last Name:BECERRA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 INTERNATIONAL LN STE 119
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3154
Mailing Address - Country:US
Mailing Address - Phone:608-467-8870
Mailing Address - Fax:
Practice Address - Street 1:2317 INTERNATIONAL LN STE 119
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3154
Practice Address - Country:US
Practice Address - Phone:608-467-8870
Practice Address - Fax:608-467-6735
Is Sole Proprietor?:No
Enumeration Date:2017-12-10
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3520-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical