Nina Petrosky Decker, LCSW
Individual provider Active NPI Social Worker · Cayucos, CA
NPI 1275348583 · NPPES record last updated Feb 12, 2025
Key facts
- NPI
- 1275348583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 10229 (CA)
- Practice address
- 2959 Richard Ave
Cayucos, CA 93430-1507 - Phone
- (805) 368-1939
- NPI assigned
- Feb 12, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10229 | CA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 10229 | CA | Yes |
Addresses
Primary practice location
2959 Richard Ave
Cayucos, CA 93430-1507
Mailing address
2959 Richard Ave
Cayucos, CA 93430-1507
Phone (805) 368-1939
Other providers in Cayucos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.