Healthcare Provider Details

I. General information

NPI: 1538810528
Provider Name (Legal Business Name): THOMAS F VACCHIO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S OYSTER BAY RD STE 101
HICKSVILLE NY
11801-3500
US

IV. Provider business mailing address

400 S OYSTER BAY RD STE 101
HICKSVILLE NY
11801-3500
US

V. Phone/Fax

Practice location:
  • Phone: 516-289-6910
  • Fax:
Mailing address:
  • Phone: 516-818-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP112332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: