Healthcare Provider Details

I. General information

NPI: 1467822007
Provider Name (Legal Business Name): JEHLISAH VACCARELLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E CHOCOLATE AVE
HERSHEY PA
17033-1117
US

IV. Provider business mailing address

336 BUCKLEY DR
HARRISBURG PA
17112-2729
US

V. Phone/Fax

Practice location:
  • Phone: 717-534-1650
  • Fax:
Mailing address:
  • Phone: 717-639-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021068
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSW132617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: