MEDICARE: DR. BROOKE COCCIA PSY.D.

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	103TC0700X	Clinical Psychologist	0810004918	VA

General Provider Information

NPI Number	:	1992127286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKE COCCIA PSY.D.

Provider Business Mailing Address
First Line	:	8620 ROLLING RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-3828
Country	:	US
Telephone Number	:	703-577-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N ST NW APT 215
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-2815
Country	:	US
Telephone Number	:	404-447-6978
Fax Number	:

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

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/13/2014

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