Provider Demographics
NPI:1659094142
Name:LUKE BROCCO, LCSW, LLC
Entity type:Organization
Organization Name:LUKE BROCCO, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:BROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-203-0214
Mailing Address - Street 1:1114 THOMASVILLE RD STE E-3
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6288
Mailing Address - Country:US
Mailing Address - Phone:850-203-0214
Mailing Address - Fax:855-595-2914
Practice Address - Street 1:1114 THOMASVILLE RD STE E-3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6288
Practice Address - Country:US
Practice Address - Phone:850-203-0214
Practice Address - Fax:855-595-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)