Provider Demographics
NPI:1053151357
Name:BECKER, SHARON M (LSP, NCSP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:BECKER
Suffix:
Gender:F
Credentials:LSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 SE GALT CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6343
Mailing Address - Country:US
Mailing Address - Phone:772-359-9476
Mailing Address - Fax:
Practice Address - Street 1:3053 SE GALT CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-6343
Practice Address - Country:US
Practice Address - Phone:772-359-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS705103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty