Provider Demographics
NPI:1851651509
Name:COCCARO, VICKI (MA, MFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:COCCARO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KATELLA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3493
Mailing Address - Country:US
Mailing Address - Phone:714-274-3451
Mailing Address - Fax:562-598-5997
Practice Address - Street 1:4132 KATELLA AVE STE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3493
Practice Address - Country:US
Practice Address - Phone:714-274-3451
Practice Address - Fax:562-598-5997
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist