Healthcare Provider Details

I. General information

NPI: 1174980429
Provider Name (Legal Business Name): MRS. INESSA VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: INESSA SHOR LPC

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDISON DR
EAST WINDSOR NJ
08520-5207
US

IV. Provider business mailing address

593 EDISON DR
EAST WINDSOR NJ
08520-5207
US

V. Phone/Fax

Practice location:
  • Phone: 732-266-9488
  • Fax:
Mailing address:
  • Phone: 732-266-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00529000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: