Healthcare Provider Details

I. General information

NPI: 1245199470
Provider Name (Legal Business Name): BROOKE DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LEO MOSS DR STE 4308
OLEAN NY
14760-1156
US

IV. Provider business mailing address

1 LEO MOSS DR STE 4308
OLEAN NY
14760-1156
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-8040
  • Fax: 716-701-3729
Mailing address:
  • Phone: 716-373-8040
  • Fax: 716-701-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: