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General NPI Number Information
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NPI Number | 1356891592
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Entity Type | Individual
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Provider Name | VINCENT DOMINICK SIROCCHI III LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 6937 N INTERSTATE 35
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City | AUSTIN
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State | TX
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Zip | 78752-3295
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Country | US
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Telephone | 512-445-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 6404 ALBANY SLEIGH DR
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City | DEL VALLE
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State | TX
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Zip | 78617-2047
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Country | US
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Telephone | 262-914-8245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 66144
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License Number State | TX
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