Provider Demographics
NPI:1114296662
Name:DECKER, DENISE (LISW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 MENAUL BLVD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3696
Mailing Address - Country:US
Mailing Address - Phone:505-220-8512
Mailing Address - Fax:
Practice Address - Street 1:7001 MENAUL BLVD NE, SUITE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4131
Practice Address - Country:US
Practice Address - Phone:505-220-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-050561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical