Provider Demographics
NPI:1205049913
Name:BECKETT, NORMAN JAMES JR (PHD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAMES
Last Name:BECKETT
Suffix:JR
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 1:1362 PACIFIC AVENUE
Mailing Address - Street 2:SUITE #216
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-345-3619
Mailing Address - Fax:
Practice Address - Street 1:1362 PACIFIC AVENUE
Practice Address - Street 2:SUITE #216
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-345-3619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical