Healthcare Provider Details

I. General information

NPI: 1649101577
Provider Name (Legal Business Name): PATTY DECOTIS THERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BOWDEN ST
MARBLEHEAD MA
01945-2355
US

IV. Provider business mailing address

23 BOWDEN ST
MARBLEHEAD MA
01945-2355
US

V. Phone/Fax

Practice location:
  • Phone: 781-632-9152
  • Fax:
Mailing address:
  • Phone: 781-632-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A DECOTIS
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 781-632-9152