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General NPI Number Information
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NPI Number | 1598004319
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Entity Type | Organization
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Legal Business Name | PETRACCO COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 22912 BAY CEDAR DR
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City | LAND O LAKES
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State | FL
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Zip | 34639-4796
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Country | US
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Telephone | 973-722-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 22912 BAY CEDAR DR
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City | LAND O LAKES
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State | FL
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Zip | 34639-4796
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND OPERATOR
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Name | MRS. HEIDI A PETRACCO
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Credential | MSW, LCSW
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Telephone | 973-722-5880
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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 | SW9771
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License Number State | FL
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