Provider Demographics
NPI:1558519215
Name:GIACONE BERARDINO, LUCILLE MARY
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARY
Last Name:GIACONE BERARDINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15175 93RD ST N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1798
Mailing Address - Country:US
Mailing Address - Phone:561-389-2283
Mailing Address - Fax:561-904-6408
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD
Practice Address - Street 2:440
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2204
Practice Address - Country:US
Practice Address - Phone:561-389-2283
Practice Address - Fax:561-904-6408
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical