Provider Demographics
NPI:1376868117
Name:BOCARDO, RICHARD (LPC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BOCARDO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E VIRGINIA AVE
Mailing Address - Street 2:275
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1195
Mailing Address - Country:US
Mailing Address - Phone:602-264-4600
Mailing Address - Fax:602-264-7325
Practice Address - Street 1:202 N LINDSAY RD
Practice Address - Street 2:203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-9294
Practice Address - Country:US
Practice Address - Phone:602-264-4600
Practice Address - Fax:602-264-7325
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11502101YA0400X
AZ11921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)