Healthcare Provider Details

I. General information

NPI: 1033126719
Provider Name (Legal Business Name): MEGAN VACCARO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E GRAND RIVER SUITE 104
HOWELL MI
48843
US

IV. Provider business mailing address

2020 E GRAND RIVER SUITE 104
HOWELL MI
48843
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-7390
  • Fax: 517-545-5944
Mailing address:
  • Phone: 517-545-7390
  • Fax: 517-545-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801079810
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: