Healthcare Provider Details

I. General information

NPI: 1891965950
Provider Name (Legal Business Name): JENNIFER VACOVSKY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

V. Phone/Fax

Practice location:
  • Phone: 801-822-9539
  • Fax:
Mailing address:
  • Phone: 801-822-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: