Healthcare Provider Details

I. General information

NPI: 1619620507
Provider Name (Legal Business Name): FRANCIS IACOBUCCI COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RAYMOND DR STE F
HAVERTOWN PA
19083-3188
US

IV. Provider business mailing address

715 20TH AVE E
SEATTLE WA
98112-4015
US

V. Phone/Fax

Practice location:
  • Phone: 484-437-1163
  • Fax:
Mailing address:
  • Phone: 484-437-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS REGINALD IACOBUCCI III
Title or Position: FOUNDER AND CEO
Credential: LCSW
Phone: 484-437-1163