Provider Demographics
NPI:1114638830
Name:LAROCCO, BRADLEY S (MSW)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:LAROCCO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 JORDAN RD APT 108
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4113
Mailing Address - Country:US
Mailing Address - Phone:815-701-6741
Mailing Address - Fax:
Practice Address - Street 1:410 JORDAN RD APT 108
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4113
Practice Address - Country:US
Practice Address - Phone:815-701-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker