Healthcare Provider Details

I. General information

NPI: 1073672200
Provider Name (Legal Business Name): PAMELA VACCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4986 N ADAMS RD
ROCHESTER MI
48306-1416
US

IV. Provider business mailing address

325 TIMBER TRL APT 308
AUBURN HILLS MI
48326-1197
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-4880
  • Fax:
Mailing address:
  • Phone: 313-920-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009087
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: