MEDICARE: DR. CATHY H DECOU PHD LICSW

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	1041C0700X	Clinical Social Worker	MA106515	MA

General Provider Information

NPI Number	:	1164731048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHY H DECOU PHD LICSW

Provider Business Mailing Address
First Line	:	115 MOUNTAIN VIEW DR
Second Line	:
City	:	BELCHERTOWN
State	:	MA
Zip	:	01007-9157
Country	:	US
Telephone Number	:	413-323-5206
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 RUSSELL ST
Second Line	:	STE 19B
City	:	HADLEY
State	:	MA
Zip	:	01035-9529
Country	:	US
Telephone Number	:	413-586-8485
Fax Number	:

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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