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General NPI Number Information
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NPI Number | 1073672200
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Entity Type | Individual
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Provider Name | PAMELA VACCARELLI
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4986 N ADAMS RD
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City | ROCHESTER
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State | MI
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Zip | 48306-1416
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Country | US
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Telephone | 248-475-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 325 TIMBER TRL APT 308
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City | AUBURN HILLS
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State | MI
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Zip | 48326-1197
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Country | US
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Telephone | 313-920-1165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301009087
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License Number State | MI
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