MEDICARE: MR. JOSEPH VACCHIANO LCSW, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00132300
2	1041C0700X	Clinical Social Worker	44SC05246900	NJ

General Provider Information

NPI Number	:	1265946941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH VACCHIANO LCSW, LCADC

Provider Business Mailing Address
First Line	:	410 BOWNE RD
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-3713
Country	:	US
Telephone Number	:	848-218-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 GEORGE ST STE 200
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2009
Country	:	US
Telephone Number	:	732-235-4410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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