Provider Demographics
NPI:1447800354
Name:DECKMAN, BRANDY ANNE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ANNE
Last Name:DECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2224
Mailing Address - Country:US
Mailing Address - Phone:716-397-2596
Mailing Address - Fax:
Practice Address - Street 1:17 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1215
Practice Address - Country:US
Practice Address - Phone:607-587-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098339-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker