Provider Demographics
NPI:1427331529
Name:DECOTIIS, CARLY (MA, NCC, LPC, ACS)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DECOTIIS
Suffix:
Gender:F
Credentials:MA, NCC, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BANK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3659
Mailing Address - Country:US
Mailing Address - Phone:908-546-2126
Mailing Address - Fax:
Practice Address - Street 1:18 BANK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3659
Practice Address - Country:US
Practice Address - Phone:908-566-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00433500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional