Healthcare Provider Details

I. General information

NPI: 1760912216
Provider Name (Legal Business Name): AMANDA ASHLEY VACCA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ASHLEY GOMES

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

4 BRAGDON AVE
DANBURY CT
06811-3410
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-5416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: