Provider Demographics
NPI:1801306915
Name:COCCA, AMY LYNN (MSED, CAADC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:COCCA
Suffix:
Gender:F
Credentials:MSED, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1032
Mailing Address - Country:US
Mailing Address - Phone:484-358-0649
Mailing Address - Fax:
Practice Address - Street 1:121 N CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4664
Practice Address - Country:US
Practice Address - Phone:484-273-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6855101YA0400X
PAPC015364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6855OtherPENNSYLVANIA CERTIFICATION BOARD