Basic Information
| Provider Information | |||||||||
| NPI: | 1609465921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOCCIO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5130 E MAIN STREET RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853441421 | ||||||||
| FaxNumber: | 5853453080 | ||||||||
| Practice Location | |||||||||
| Address1: | 5130 E MAIN STREET RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853441421 | ||||||||
| FaxNumber: | 5853453080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2021 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 111629 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 111629 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.