Provider Demographics
NPI:1225032295
Name:COCCOMA, PATRICIA (EDD LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COCCOMA
Suffix:
Gender:F
Credentials:EDD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 COLONIAL BLVD
Mailing Address - Street 2:B-910
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1013
Mailing Address - Country:US
Mailing Address - Phone:239-936-9337
Mailing Address - Fax:239-542-5248
Practice Address - Street 1:1342 COLONIAL BLVD
Practice Address - Street 2:B-910
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1013
Practice Address - Country:US
Practice Address - Phone:239-936-9337
Practice Address - Fax:239-542-5248
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTH000Medicare UPIN
FLZ7653Medicare ID - Type Unspecified