Provider Demographics
NPI:1679970362
Name:BECCERA, MELISSA (APSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BECCERA
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4650 W SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-9106
Mailing Address - Country:US
Mailing Address - Phone:920-903-1060
Mailing Address - Fax:920-903-1060
Practice Address - Street 1:4650 W SPENCER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-9106
Practice Address - Country:US
Practice Address - Phone:920-903-1060
Practice Address - Fax:920-903-1060
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1349991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical