MEDICARE: SUSAN ROMAINE DECKER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC007999	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477892743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ROMAINE DECKER LPC

Provider Business Mailing Address
First Line	:	7 DOCK HILL RD
Second Line	:
City	:	MIDDLEBURG
State	:	PA
Zip	:	17842-8910
Country	:	US
Telephone Number	:	570-837-2123
Fax Number	:	570-837-2185

Provider Business Practice Location Address
First Line	:	270 SUSQUEHANNA VALLEY MALL DR STE 100
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-9115
Country	:	US
Telephone Number	:	708-847-9225
Fax Number	:	570-768-4195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	04/14/2022

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