Provider Demographics
NPI:1306984901
Name:DECH, ERIC JEROME (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEROME
Last Name:DECH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6406
Mailing Address - Country:US
Mailing Address - Phone:724-816-0580
Mailing Address - Fax:724-776-5611
Practice Address - Street 1:215 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6406
Practice Address - Country:US
Practice Address - Phone:724-816-0580
Practice Address - Fax:724-776-5611
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01947790Medicaid
PA01947790Medicaid