Provider Demographics
NPI:1396932679
Name:LOCICERO, JOSEPH ANTHONY (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:LOCICERO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N WOODLYNNE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1555
Mailing Address - Country:US
Mailing Address - Phone:813-348-9353
Mailing Address - Fax:813-348-0202
Practice Address - Street 1:609 N WOODLYNNE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1555
Practice Address - Country:US
Practice Address - Phone:813-348-9353
Practice Address - Fax:813-348-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6843328Medicaid