Healthcare Provider Details

I. General information

NPI: 1053046540
Provider Name (Legal Business Name): CASEY LEE VACCARO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASEY LEE FERRI PSY.D.

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 DALLAS PKWY STE 575
PLANO TX
75024-4260
US

IV. Provider business mailing address

5910 N CENTRAL EXPY # 182
DALLAS TX
75206-5125
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-2345
  • Fax:
Mailing address:
  • Phone: 214-363-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: