Provider Demographics
NPI:1093933590
Name:DR CARMINE PECORARO PSY D & ASSOCIATES P A
Entity Type:Organization
Organization Name:DR CARMINE PECORARO PSY D & ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PECORARO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CBHT
Authorized Official - Phone:954-829-4644
Mailing Address - Street 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:317
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-463-2723
Mailing Address - Fax:954-463-1687
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:317
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-463-2723
Practice Address - Fax:954-463-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7477101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF405OtherMEDICARE PTAN