MEDICARE: PATRICIA COCCOMA EDD LCSW

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	1041C0700X	Clinical Social Worker	SW4483	FL

General Provider Information

NPI Number	:	1225032295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA COCCOMA EDD LCSW

Provider Business Mailing Address
First Line	:	PO BOX 15292
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28408-5292
Country	:	US
Telephone Number	:	239-939-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	12590 WHITEHALL DR STE 3
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4680
Country	:	US
Telephone Number	:	239-939-9090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	09/30/2024

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