Provider Demographics
NPI:1326199480
Name:DECANIO, CHRISTOPHER C (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:DECANIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 S BRADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-722-9472
Mailing Address - Fax:540-722-9473
Practice Address - Street 1:133 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-722-9472
Practice Address - Fax:540-722-9473
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003294103TC0700X
NY0149931103TC0700X
VAPPS0600035103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
115027460002OtherCIGNA
801821OtherSENTARA
VA279395OtherANTHEM
0007141537OtherAETNA
V735YOtherEMPIRE BCBS
227704OtherCOMPSYCH
331110OtherMHN
801821OtherVALLEY HEALTH
1149097OtherCIGNA BH