Provider Demographics
NPI:1356165245
Name:DECARIA, SIENNA MARIE (NCC, LAC)
Entity type:Individual
Prefix:
First Name:SIENNA
Middle Name:MARIE
Last Name:DECARIA
Suffix:
Gender:F
Credentials:NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 GAITHER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1740
Mailing Address - Country:US
Mailing Address - Phone:610-389-1382
Mailing Address - Fax:
Practice Address - Street 1:161 GAITHER DR STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1740
Practice Address - Country:US
Practice Address - Phone:610-389-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1734515101YM0800X
NJ37AC00826700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health