Provider Demographics
NPI:1902277213
Name:COCOA COUNSELING CENTER
Entity Type:Organization
Organization Name:COCOA COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:JAEME
Authorized Official - Middle Name:TANENE
Authorized Official - Last Name:SCHWARTZ-BOGRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:717-298-1366
Mailing Address - Street 1:1512 E CARACAS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1184
Mailing Address - Country:US
Mailing Address - Phone:717-298-1238
Mailing Address - Fax:
Practice Address - Street 1:1512 E CARACAS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1184
Practice Address - Country:US
Practice Address - Phone:717-298-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1760808554Medicaid