Healthcare Provider Details

I. General information

NPI: 1417205824
Provider Name (Legal Business Name): ANITA THERESA VACCARO M.A. MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 N MONTE CRISTO WAY
LAS VEGAS NV
89131-3333
US

IV. Provider business mailing address

7335 N MONTE CRISTO WAY
LAS VEGAS NV
89131-3333
US

V. Phone/Fax

Practice location:
  • Phone: 702-845-9989
  • Fax:
Mailing address:
  • Phone: 702-845-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01013
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: