Healthcare Provider Details

I. General information

NPI: 1215217955
Provider Name (Legal Business Name): JILL ANN VACCHIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BOWNE RD
OCEAN NJ
07712-3713
US

IV. Provider business mailing address

410 BOWNE RD
OCEAN NJ
07712-3713
US

V. Phone/Fax

Practice location:
  • Phone: 732-455-5141
  • Fax:
Mailing address:
  • Phone: 732-455-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05243900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: