Healthcare Provider Details

I. General information

NPI: 1902154925
Provider Name (Legal Business Name): DANAMARIE VACCARA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HALF HOLLOW RD
DIX HILLS NY
11746-5861
US

IV. Provider business mailing address

197 HALF HOLLOW RD
DIX HILLS NY
11746-5861
US

V. Phone/Fax

Practice location:
  • Phone: 631-370-1705
  • Fax:
Mailing address:
  • Phone: 631-370-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number083819
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number083819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: