Provider Demographics
NPI:1003058256
Name:DECKER, MARGARET MARY (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:DECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DOVE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2432
Mailing Address - Country:US
Mailing Address - Phone:949-922-1529
Mailing Address - Fax:949-809-5779
Practice Address - Street 1:1600 DOVE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2432
Practice Address - Country:US
Practice Address - Phone:949-922-1529
Practice Address - Fax:949-809-5779
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist