MEDICARE: MS. ANNALISA J DECINA LPC

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	101Y00000X	Counselor	C2553	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700948361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNALISA J DECINA LPC

Provider Business Mailing Address
First Line	:	561 W OLIVE ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-3720
Country	:	US
Telephone Number	:	541-264-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 NE AVERY ST
Second Line	:	STE B
City	:	NEWPORT
State	:	OR
Zip	:	97365-3038
Country	:	US
Telephone Number	:	541-264-6017
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/26/2016

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