Provider Demographics
NPI:1578922928
Name:LAROCCO, ANGELO J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:J
Last Name:LAROCCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 5TH AVE SE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2416
Mailing Address - Country:US
Mailing Address - Phone:319-286-4545
Mailing Address - Fax:319-368-3358
Practice Address - Street 1:1030 5TH AVE SE
Practice Address - Street 2:SUITE 3000
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2416
Practice Address - Country:US
Practice Address - Phone:319-286-4545
Practice Address - Fax:319-368-3358
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009215103T00000X
IA082291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist