Provider Demographics
NPI:1053937748
Name:BECK, GREGORY (CSW)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CAMINO CINCO SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7505
Mailing Address - Country:US
Mailing Address - Phone:505-250-4749
Mailing Address - Fax:505-856-7946
Practice Address - Street 1:305 CAMINO CINCO SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-7505
Practice Address - Country:US
Practice Address - Phone:505-250-4749
Practice Address - Fax:505-856-7946
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator