Provider Demographics
NPI:1164632873
Name:SACCO, JOHN (CADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SACCO
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 BIRD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2804
Mailing Address - Country:US
Mailing Address - Phone:203-300-6000
Mailing Address - Fax:203-330-6005
Practice Address - Street 1:361 BIRD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2804
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-330-6005
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YA0400X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000375OtherSTATE LICENSE