Healthcare Provider Details

I. General information

NPI: 1992433593
Provider Name (Legal Business Name): AUGUSTINE CROCCO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 12TH AVE STE 320
POMPANO BEACH FL
33069-3238
US

IV. Provider business mailing address

3980 LONE PINE RD
DELRAY BEACH FL
33445-7650
US

V. Phone/Fax

Practice location:
  • Phone: 877-321-7658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: