Provider Demographics
NPI:1437365855
Name:DECKER, BEVERLY (MSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W. 90TH ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:20024
Mailing Address - Country:US
Mailing Address - Phone:212-875-9252
Mailing Address - Fax:
Practice Address - Street 1:35 W 90TH ST
Practice Address - Street 2:7H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1507
Practice Address - Country:US
Practice Address - Phone:212-873-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0243071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN122310Medicare PIN