MEDICARE: MS. ELLEN DECKOFF LCSW

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	44SC05179100	NJ

General Provider Information

NPI Number	:	1609907609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN DECKOFF LCSW

Provider Business Mailing Address
First Line	:	4 EPHRAIM RD
Second Line	:
City	:	CLARKSBURG
State	:	NJ
Zip	:	08510-1621
Country	:	US
Telephone Number	:	609-208-2044
Fax Number	:	609-208-2045

Provider Business Practice Location Address
First Line	:	4 EPHRAIM RD
Second Line	:
City	:	CLARKSBURG
State	:	NJ
Zip	:	08510-1621
Country	:	US
Telephone Number	:	609-208-2044
Fax Number	:	609-208-2045

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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