Provider Demographics
NPI:1356712004
Name:COCCARO, CARL (MS, LPC, SUD, NCC)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:COCCARO
Suffix:
Gender:M
Credentials:MS, LPC, SUD, NCC
Other - Prefix:MR
Other - First Name:CARL
Other - Middle Name:
Other - Last Name:COCCARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, SUD, NCC
Mailing Address - Street 1:49 KESSEL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 KESSEL CT STE 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6275
Practice Address - Country:US
Practice Address - Phone:608-280-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2651266101YM0800X
WI17503130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health