Provider Demographics
NPI:1730748666
Name:BROCCO, LUKE BYRON (LCSW)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:BYRON
Last Name:BROCCO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW200291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104100000XMedicaid