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General NPI Number Information
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NPI Number | 1861607715
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Entity Type | Organization
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Legal Business Name | VINCENT P. VECERA
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 600 E MAIN ST STE 2
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City | RICHMOND
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State | IN
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Zip | 47374-4300
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Country | US
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Telephone | 765-966-1180
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Fax | 765-966-4626
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Provider Business Mailing Address
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Address Line | 600 E MAIN ST STE 2
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City | RICHMOND
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State | IN
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Zip | 47374-4300
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Country | US
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Telephone | 765-966-1180
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Fax | 765-966-4626
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Authorized Official
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Title or Position | OWNER
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Name | MR. VINCENT P VECERA
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Credential | HSPP
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Telephone | 765-966-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20050003A
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License Number State | IN
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