Healthcare Provider Details

I. General information

NPI: 1457229221
Provider Name (Legal Business Name): AUTUMN DECKER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE STE 132
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

5012 MORENCI LN
LITTLE NECK NY
11362-1332
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax:
Mailing address:
  • Phone: 347-287-5675
  • Fax:

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: