Provider Demographics
NPI:1689413239
Name:BECTON, MIA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:ANN
Last Name:BECTON
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 1:1 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2129
Mailing Address - Country:US
Mailing Address - Phone:203-530-8191
Mailing Address - Fax:
Practice Address - Street 1:1 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2129
Practice Address - Country:US
Practice Address - Phone:203-530-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC1220200010611041S0200X
CT0132741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool