Jodie Decourcey, LMSW
Individual provider Active NPI Mental Health Counselor · Grand Island, NY
NPI 1679284533 · NPPES record last updated May 30, 2023
Key facts
- NPI
- 1679284533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 112703-01 (NY)
- Practice address
- 1329 E Park Rd
Grand Island, NY 14072-2314 - Phone
- (716) 983-9326
- NPI assigned
- Dec 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250627003331 | NY | Order and Referring Only - Clinical Social Worker | 8123531621 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112703-01 | NY | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 112703-01 | NY | Yes |
Addresses
Primary practice location
1329 E Park Rd
Grand Island, NY 14072-2314
Mailing address
779 Cayuga St Ste D
Lewiston, NY 14092-1728
Phone (716) 404-5545
Other providers in Grand Island, NY
- Barbara A Dahill
- Melissa Ann Dains
- Joshua Dawson
- Linda Ann Decarolis
- Jessica Decker
- Sabrina Defilippis
- Dana Deluke
- Ashley Dietz
- Kathleen Kennedy Dilaura
- Lisa Dolan
All providers in Grand Island, NY · Mental Health Counselor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.