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General NPI Number Information
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NPI Number | 1639154859
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Entity Type | Individual
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Provider Name | TERESA M. DECKER LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3985 ONEIDA ST
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City | NEW HARTFORD
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State | NY
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Zip | 13413-9733
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Country | US
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Telephone | 315-737-5463
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Fax |
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Provider Business Mailing Address
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Address Line | 4 FOREST RD
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City | UTICA
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State | NY
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Zip | 13501-6623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PR046076-1
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License Number State | NY
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