Provider Demographics
NPI:1952809832
Name:DECANO, POLICARPIO AUGUSTINE (MA, EDS, PHC)
Entity Type:Individual
Prefix:MR
First Name:POLICARPIO
Middle Name:AUGUSTINE
Last Name:DECANO
Suffix:
Gender:M
Credentials:MA, EDS, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MERCER ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3958
Mailing Address - Country:US
Mailing Address - Phone:206-420-4701
Mailing Address - Fax:
Practice Address - Street 1:200 W MERCER ST STE 111
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3958
Practice Address - Country:US
Practice Address - Phone:206-420-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health