Provider Demographics
NPI:1033328026
Name:BECKER, JOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
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:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-0088
Mailing Address - Country:US
Mailing Address - Phone:860-774-1350
Mailing Address - Fax:860-774-1350
Practice Address - Street 1:55 GREEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3533
Practice Address - Country:US
Practice Address - Phone:860-774-1350
Practice Address - Fax:860-774-1350
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist