Provider Demographics
NPI:1730582958
Name:DECKER, JEAN MARIE (LSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:DECKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1323
Mailing Address - Country:US
Mailing Address - Phone:570-589-9294
Mailing Address - Fax:570-961-3364
Practice Address - Street 1:4101 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1323
Practice Address - Country:US
Practice Address - Phone:570-589-9294
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical