Individual
MS. CAROL DECLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, LCSW
Contact information
Practice address
1400 NOYES STREET, MOHAWK VALLEY PSYCHIATRIC CENTER- YORK STREET CLINIC, UTICA, NY 13502
(315) 738-2660
(315) 738-4410
Mailing address
3413 STATE HIGHWAY 8, SOUTH NEW BERLIN, NY 13843-2120
(607) 859-2231
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
067256
NY
1041C0700X
Clinical Social Worker
Primary
075896
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
713667
MVP MOHAWK VALLEY PLAN
NY
Enumeration date
08/29/2006
Last updated
07/13/2010
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