Provider Demographics
NPI:1053416545
Name:BECKETT, LACI (LCSW)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:
Last Name:BECKETT
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 1:355 S END AVE
Mailing Address - Street 2:8E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1005
Mailing Address - Country:US
Mailing Address - Phone:212-945-6260
Mailing Address - Fax:
Practice Address - Street 1:124 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2339
Practice Address - Country:US
Practice Address - Phone:718-771-3136
Practice Address - Fax:718-773-4273
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070786-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical