Provider Demographics
NPI:1679284533
Name:DECOURCEY, JODIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:
Last Name:DECOURCEY
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 1:779 CAYUGA ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1728
Mailing Address - Country:US
Mailing Address - Phone:716-404-5545
Mailing Address - Fax:
Practice Address - Street 1:1329 E PARK RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2314
Practice Address - Country:US
Practice Address - Phone:716-983-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112703-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health