Provider Demographics
NPI:1861739906
Name:POPOWSKI, BECKY R (LCSW)
Entity type:Individual
Prefix:MISS
First Name:BECKY
Middle Name:R
Last Name:POPOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 EMBARCADERO DR APT 7
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3348
Mailing Address - Country:US
Mailing Address - Phone:209-323-4332
Mailing Address - Fax:
Practice Address - Street 1:2529 W MARCH LN
Practice Address - Street 2:SUITE 203
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8270
Practice Address - Country:US
Practice Address - Phone:209-403-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical