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1538825922
MATTHEW MARCOS BACCA
FORT DRUM, NY
NPI
1538825922
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: CO lsw.009924321)
Enumeration Date
2021-11-10
Last Update Date
2023-02-09
Business Address
MATTHEW MARCOS BACCA LSW
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602-5438
Phone number: 719-634-8365
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Mailing Address
MATTHEW MARCOS BACCA LSW
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602-5438
Phone number: 315-772-6976
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