Paul Joseph Decancq, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

014228-1 Issued in NY

Practice address

400 Fort Hill Ave
532 / 300 / B2
Canandaigua, NY 14424-1159

Phone

(585) 393-7225

Fax

(585) 393-8380

NPI assigned

May 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1871530089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FORT HILL AVE",
            "address_2": "532 / 300 / B2",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241159",
            "telephone_number": "585-393-7225",
            "fax_number": "585-393-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FORT HILL AVE",
            "address_2": "532 / 300 / B2",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241159",
            "telephone_number": "585-393-7225",
            "fax_number": "585-393-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECANCQ",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014228-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P010014228",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS / BLUE SHIELD",
            "identifier": "PDE760144",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "106215FC",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Thomas Davidson, LMSW
• Kelly Davis, MA CCC-SLP
• Richard Kenneth Davis, MSW
• Sarah Elizabeth Day, DDS
• Kathryn A Debruin, LCSW-R
• Nicole Marie Defayette, FNP
• Tammie S Delforte-Papas, LMSW
• Lydia Delgado, CTRS
• Tanya Denee
• Dentistry Today

• Clinical Psychologist in Canandaigua, NY
• Providers in Canandaigua, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.