Healthcare Provider Details

I. General information

NPI: 1043630379
Provider Name (Legal Business Name): JEFFREY VACCARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CUMMINGS CTR SUITE 364-U
BEVERLY MA
01915-6175
US

IV. Provider business mailing address

800 CUMMINGS CTR SUITE 364-U
BEVERLY MA
01915-6175
US

V. Phone/Fax

Practice location:
  • Phone: 978-998-3680
  • Fax: 978-922-0098
Mailing address:
  • Phone: 978-998-3680
  • Fax: 978-922-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: