Provider Demographics
NPI:1669725768
Name:DECKARD, AMY REBECCA (BSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:DECKARD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LONG POND RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2662
Mailing Address - Country:US
Mailing Address - Phone:508-746-5632
Mailing Address - Fax:
Practice Address - Street 1:60 PERSEVERANCE WAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1843
Practice Address - Country:US
Practice Address - Phone:508-862-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor