Provider Demographics
NPI:1609989318
Name:BOCCIA, MICHAEL R JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:BOCCIA
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RTE 9 & GRAYMOOR
Mailing Address - Street 2:ST. CHRISTOPHER'S INN
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524
Mailing Address - Country:US
Mailing Address - Phone:845-424-3616
Mailing Address - Fax:845-424-3598
Practice Address - Street 1:RTE 9 & GRAYMOOR
Practice Address - Street 2:ST. CHRISTOPHER'S INN
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524
Practice Address - Country:US
Practice Address - Phone:845-424-3616
Practice Address - Fax:845-424-3598
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070345-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical