Healthcare Provider Details

I. General information

NPI: 1184934911
Provider Name (Legal Business Name): BRENDA G VACCARO MA, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 S ST STE 100
SACRAMENTO CA
95811-7155
US

IV. Provider business mailing address

1412 S ST STE 100
SACRAMENTO CA
95811-7155
US

V. Phone/Fax

Practice location:
  • Phone: 916-616-8561
  • Fax: 916-914-2074
Mailing address:
  • Phone: 916-616-8561
  • Fax: 916-914-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB34264
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: