Provider Demographics
NPI:1366082034
Name:BECKER, JILL ANN (MA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1087 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3545
Mailing Address - Country:US
Mailing Address - Phone:401-383-2200
Mailing Address - Fax:
Practice Address - Street 1:1087 WARWICK AVE REAR UNIT
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-383-2200
Practice Address - Fax:401-256-5209
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor