Healthcare Provider Details

I. General information

NPI: 1497123103
Provider Name (Legal Business Name): CRISTINA VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 23RD ST 9TH FLOOR
NEW YORK NY
10010-5205
US

IV. Provider business mailing address

50 W 23RD ST 9TH FLOOR
NEW YORK NY
10010-5205
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-2990
  • Fax:
Mailing address:
  • Phone: 212-989-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: