Healthcare Provider Details

I. General information

NPI: 1639940273
Provider Name (Legal Business Name): KEERY VACCARO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 JAMES ST STE 100
SYRACUSE NY
13203-2758
US

IV. Provider business mailing address

1045 JAMES ST STE 100
SYRACUSE NY
13203-2758
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-4471
  • Fax:
Mailing address:
  • Phone: 315-472-4471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: