MEDICARE: DR CARMINE PECORARO PSY D & ASSOCIATES P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	PY7477	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AF405	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1093933590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR CARMINE PECORARO PSY D & ASSOCIATES P A

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DR
Second Line	:	317
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3544
Country	:	US
Telephone Number	:	954-463-2723
Fax Number	:	954-463-1687

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR
Second Line	:	317
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3544
Country	:	US
Telephone Number	:	954-463-2723
Fax Number	:	954-463-1687

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. JUDITH ANN PECORARO
Credential	:	BS, CBHT
Telephone Number	:	954-829-4644

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	04/08/2008

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Directions to “DR CARMINE PECORARO PSY D & ASSOCIATES P A ” Practice Location

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