Provider Demographics
NPI:1588317556
Name:DECARY, ANDRE EDOUARD
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:EDOUARD
Last Name:DECARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDRE
Other - Middle Name:EDOUARD
Other - Last Name:DECARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2440 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1114
Mailing Address - Country:US
Mailing Address - Phone:510-549-1586
Mailing Address - Fax:
Practice Address - Street 1:376 COLUSA AVE STE 1
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94707-1213
Practice Address - Country:US
Practice Address - Phone:510-549-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT28850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist