Healthcare Provider Details

I. General information

NPI: 1558680801
Provider Name (Legal Business Name): LOUANN RUTH VACCARELLA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N OLIVE ST
MEDIA PA
19063-2418
US

IV. Provider business mailing address

600 N OLIVE ST
MEDIA PA
19063-2418
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-7540
  • Fax: 610-566-7677
Mailing address:
  • Phone: 610-566-7540
  • Fax: 610-566-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: