Provider Demographics
NPI:1811946577
Name:DECORTE, MICHELLE ANGELA (RN, LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANGELA
Last Name:DECORTE
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:A
Other - Last Name:DECORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 814
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1726
Mailing Address - Country:US
Mailing Address - Phone:650-483-3845
Mailing Address - Fax:650-347-9777
Practice Address - Street 1:520 S EL CAMINO REAL
Practice Address - Street 2:SUITE 814
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1726
Practice Address - Country:US
Practice Address - Phone:650-483-3845
Practice Address - Fax:650-347-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW190310Medicaid
CAZZZ21547ZMedicare ID - Type Unspecified
CACSW190310Medicaid