Provider Demographics
NPI:1801855945
Name:DECORTE, BRENDA (LPC)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:DECORTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4598 S MECHANICSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-4726
Mailing Address - Country:US
Mailing Address - Phone:814-764-3821
Mailing Address - Fax:814-226-0205
Practice Address - Street 1:68 HIMES RD
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-4702
Practice Address - Country:US
Practice Address - Phone:814-226-9810
Practice Address - Fax:814-226-0205
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001526014OtherKEYSTONE WEST HIGHMARK
PA533590OtherVALUE OPTIONS