Provider Demographics
NPI:1093186777
Name:SCIPPIO, DECARLOS KOUVARIS (LCSW)
Entity type:Individual
Prefix:
First Name:DECARLOS
Middle Name:KOUVARIS
Last Name:SCIPPIO
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 1:226 SW PINE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024
Mailing Address - Country:US
Mailing Address - Phone:386-344-8355
Mailing Address - Fax:
Practice Address - Street 1:226 SW PINE FOREST CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024
Practice Address - Country:US
Practice Address - Phone:386-344-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW216141041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS100-171-87-297-0OtherDRIVER LICENSE