Healthcare Provider Details

I. General information

NPI: 1760281935
Provider Name (Legal Business Name): VACA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WELLINGTON ST
BROCKTON MA
02301-5033
US

IV. Provider business mailing address

68 HARRISON AVE STE 605
BOSTON MA
02111-1929
US

V. Phone/Fax

Practice location:
  • Phone: 857-675-2503
  • Fax: 857-328-0215
Mailing address:
  • Phone: 857-675-2503
  • Fax: 857-328-0215

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: VANESSA VACA
Title or Position: LICSW/OWNER
Credential:
Phone: 857-675-2503