Provider Demographics
NPI:1871030924
Name:MARCOCCIA, ADRIANO (PHD)
Entity Type:Individual
Prefix:
First Name:ADRIANO
Middle Name:
Last Name:MARCOCCIA
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 1:64 LEXINGTON GDNS
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3473
Mailing Address - Country:US
Mailing Address - Phone:203-520-7588
Mailing Address - Fax:
Practice Address - Street 1:200 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2207
Practice Address - Country:US
Practice Address - Phone:203-654-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003120101YP2500X
CT003938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional