MEDICARE: VACCARO CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	01013	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	106H00000X	Marriage & Family Therapist	01013	NV
4	101YM0800X	Mental Health Counselor	01013	NV

General Provider Information

NPI Number	:	1205141025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VACCARO CONSULTING, LLC

Provider Business Mailing Address
First Line	:	3425 CLIFF SHADOWS PKWY STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5112
Country	:	US
Telephone Number	:	702-845-9989
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 CLIFF SHADOWS PKWY
Second Line	:	STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5111
Country	:	US
Telephone Number	:	702-845-9989
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ANITA THERESA VACCARO
Credential	:	MA
Telephone Number	:	702-845-9989

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	06/05/2015

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