Provider Demographics
NPI:1306461272
Name:DECK, PREMELA G (LCSW)
Entity type:Individual
Prefix:
First Name:PREMELA
Middle Name:G
Last Name:DECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3021
Mailing Address - Country:US
Mailing Address - Phone:781-828-7660
Mailing Address - Fax:781-712-1234
Practice Address - Street 1:789 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3021
Practice Address - Country:US
Practice Address - Phone:781-828-7660
Practice Address - Fax:781-712-1234
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker