Healthcare Provider Details

I. General information

NPI: 1356712004
Provider Name (Legal Business Name): CARL COCCARO MS, LPC, SUD, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARL COCCARO MS, LPC, SUD, NCC

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 KESSEL CT STE 105
MADISON WI
53711-6275
US

IV. Provider business mailing address

49 KESSEL CT
MADISON WI
53711-6275
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number78072
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17503130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: