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General NPI Number Information
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NPI Number | 1093933590
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Entity Type | Organization
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Legal Business Name | DR CARMINE PECORARO PSY D & ASSOCIATES P A
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR 317
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3544
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Country | US
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Telephone | 954-463-2723
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Fax | 954-463-1687
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Provider Business Mailing Address
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Address Line | 915 MIDDLE RIVER DR 317
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3544
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Country | US
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Telephone | 954-463-2723
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Fax | 954-463-1687
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. JUDITH ANN PECORARO
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Credential | BS, CBHT
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Telephone | 954-829-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PY7477
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License Number State | FL
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