Healthcare Provider Details

I. General information

NPI: 1265946941
Provider Name (Legal Business Name): JOSEPH VACCHIANO LCSW, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GEORGE ST STE 200
NEW BRUNSWICK NJ
08901-2009
US

IV. Provider business mailing address

410 BOWNE RD
OCEAN NJ
07712-3713
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-4410
  • Fax:
Mailing address:
  • Phone: 848-218-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00132300
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05246900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: