MEDICARE: OLIVIA DECAS LMSW

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	104100000X	Social Worker	104925-01	NY

General Provider Information

NPI Number	:	1841867918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DECAS LMSW

Provider Business Mailing Address
First Line	:	29 HARMAN ST APT 528
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-6625
Country	:	US
Telephone Number	:	508-728-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 HARMAN ST APT 528
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-6625
Country	:	US
Telephone Number	:	508-728-6545
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/08/2021

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