National Provider Identifier
Mary Sue Decotiis, LCSW-R
Mary Sue Decotiis, LCSW-R is listed in the NPPES registry with a primary specialty of Clinical Social Worker in Ithaca, NY and a listed phone number of (607) 273-7494.
Profile Overview
- NPI
- 1841451523
- Provider Type
- Individual
- Primary Specialty
- Clinical Social Worker
- Enumeration Date
- June 24, 2008
- Last Updated
- October 10, 2011
Practice Location
- 127 W State St
- Ithaca, NY 14850-5474
Phone: (607) 273-7494
Specialties
- Clinical Social Worker (1041C0700X)
Full Record
- NPI
- 1841451523
- Entity Type
- Individual
- Last Name
- Decotiis
- First Name
- Mary
- Middle Name
- Sue
- Credential
- LCSW-R
- Provider Other Last Name
- Decotiis
- Provider Other First Name
- Sue
- Provider Other Middle Name
- Chapin
- Provider Other Credential Text
- LCSW-R
- Provider Other Last Name Type Code
- 2
- Mailing Street Address
- 127 W State St
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-5474
- Mailing Country
- US
- Mailing Phone
- (607) 273-7494
- Mailing Fax
- (607) 273-7484
- Practice Street Address
- 127 W State St
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-5474
- Practice Country
- US
- Practice Phone
- (607) 273-7494
- Practice Fax
- (607) 273-7484
- Enumeration Date
- June 24, 2008
- Last Updated
- October 10, 2011
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Clinical Social Worker (1041C0700X)