Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 007145-1 | NY |
N | 103TC1900X | Counseling Psychologist | SI 00290200 | NJ |
NPI | 1316083553 |
---|---|
Provider Name | Vincent Vaccaro |
First Address | Englewood, NJ 07631-2535 |
Second Address | Englewood, NJ 07631-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |