Provider Demographics
NPI:1265045918
Name:LOCASCIO, BRIAN J (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:LOCASCIO
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 SORRENTO VALLEY RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1622
Mailing Address - Country:US
Mailing Address - Phone:858-457-2200
Mailing Address - Fax:
Practice Address - Street 1:10455 SORRENTO VALLEY RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1622
Practice Address - Country:US
Practice Address - Phone:858-457-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist