Healthcare Provider Details

I. General information

NPI: 1235550906
Provider Name (Legal Business Name): BRITNEY MARIE VACCARO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 PUMP RD # 290
HENRICO VA
23233-1111
US

IV. Provider business mailing address

3420 PUMP RD # 290
HENRICO VA
23233-1111
US

V. Phone/Fax

Practice location:
  • Phone: 804-937-3394
  • Fax:
Mailing address:
  • Phone: 804-937-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: