Provider Demographics
NPI:1871530089
Name:DECANCQ, PAUL JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:DECANCQ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FORT HILL AVE
Mailing Address - Street 2:532 / 300 / B2
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1159
Mailing Address - Country:US
Mailing Address - Phone:585-393-7225
Mailing Address - Fax:585-393-8380
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:532 / 300 / B2
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-7225
Practice Address - Fax:585-393-8380
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014228-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010014228OtherBLUE CHOICE
NYPDE760144OtherBLUECROSS / BLUE SHIELD
NY106215FCOtherPREFERRED CARE