Healthcare Provider Details

I. General information

NPI: 1902328768
Provider Name (Legal Business Name): VANESSA CATE VACCARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 APPLETON ST
HOLYOKE MA
01040-4186
US

IV. Provider business mailing address

30 QUAIL HOLLOW RD
GLENMONT NY
12077-4425
US

V. Phone/Fax

Practice location:
  • Phone: 518-860-8176
  • Fax:
Mailing address:
  • Phone: 518-860-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: