Healthcare Provider Details

I. General information

NPI: 1154891380
Provider Name (Legal Business Name): TERRENCE VACCARO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 N KENDALL DR STE 415
MIAMI FL
33156-7565
US

IV. Provider business mailing address

7700 N KENDALL DR STE 415
MIAMI FL
33156-7565
US

V. Phone/Fax

Practice location:
  • Phone: 786-251-6022
  • Fax:
Mailing address:
  • Phone: 786-251-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1287
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: