Provider Demographics
NPI:1659678472
Name:PROCACCINO, ANTHONY THOMAS JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:PROCACCINO
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1 DONAHUE AVE. NUMBER TWO ELEMENTARY SCHOOL
Mailing Address - Street 2:LAWRENCE PUBLIC SCHOOLS
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096
Mailing Address - Country:US
Mailing Address - Phone:516-295-6212
Mailing Address - Fax:516-295-6213
Practice Address - Street 1:1 DONAHUE AVE. NUMBER TWO ELEMENTARY SCHOOL
Practice Address - Street 2:LAWRENCE PUBLIC SCHOOLS
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096
Practice Address - Country:US
Practice Address - Phone:516-295-6212
Practice Address - Fax:516-295-6213
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014013103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool