Provider Demographics
NPI:1033366620
Name:DECAPITE, DANA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:DECAPITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 FOUNTAIN SQ
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2552
Mailing Address - Country:US
Mailing Address - Phone:248-634-6303
Mailing Address - Fax:248-634-1746
Practice Address - Street 1:12850 FOUNTAIN SQ
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2552
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:248-634-1746
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010840511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910932OtherBLUE CROSS
MI750910401OtherBLUE CROSS
MI750910402OtherBLUE CROSS
MI750910681OtherBLUE CROSS