Provider Demographics
NPI:1376653741
Name:PROCACCIO, JOAN (MFT, LPCMH)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PROCACCIO
Suffix:
Gender:F
Credentials:MFT, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32180 OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3663
Mailing Address - Country:US
Mailing Address - Phone:302-542-6394
Mailing Address - Fax:302-966-0006
Practice Address - Street 1:32180 OAK DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3663
Practice Address - Country:US
Practice Address - Phone:302-542-6394
Practice Address - Fax:302-966-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health