Provider Demographics
NPI:1144326893
Name:DECKER, KHRISTOPHER (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:KHRISTOPHER
Middle Name:
Last Name:DECKER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MAIN ST APT 410
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1718
Mailing Address - Country:US
Mailing Address - Phone:716-512-8132
Mailing Address - Fax:
Practice Address - Street 1:712 MAIN ST APT 410
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1718
Practice Address - Country:US
Practice Address - Phone:715-512-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0590191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical