Provider Demographics
NPI:1891873089
Name:DECKER, JEANNE E (PHD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:E
Last Name:DECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 THREE CHOPT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229
Mailing Address - Country:US
Mailing Address - Phone:804-282-6165
Mailing Address - Fax:804-282-3038
Practice Address - Street 1:8921 THREE CHOPT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-282-6165
Practice Address - Fax:804-282-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
VA0810000920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R61329Medicare UPIN
VAR61329Medicare UPIN
620953216Medicare ID - Type Unspecified