Provider Demographics
NPI:1043976723
Name:LOIACONO, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LOIACONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILKERN ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1732
Mailing Address - Country:US
Mailing Address - Phone:570-762-5199
Mailing Address - Fax:
Practice Address - Street 1:1003 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4002
Practice Address - Country:US
Practice Address - Phone:570-846-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst