Basic Information
| Provider Information | |||||||||
| NPI: | 1093256513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKMAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | CASAC-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 W 125TH ST FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128644128 | ||||||||
| FaxNumber: | 2126629193 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 W 125TH ST FL 11 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128644128 | ||||||||
| FaxNumber: | 2126629193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2017 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.