Healthcare Provider Details

I. General information

NPI: 1851441810
Provider Name (Legal Business Name): LARRY SAMUEL MORICCA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 POLLASKY AVE #210
CLOVIS CA
93612-1875
US

IV. Provider business mailing address

12588 CADES BAY CIR
BRADENTON FL
34211-1604
US

V. Phone/Fax

Practice location:
  • Phone: 559-999-0143
  • Fax: 559-412-2104
Mailing address:
  • Phone: 559-999-0143
  • Fax: 559-412-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: