Provider Demographics
NPI:1154891380
Name:VACCARO, TERRENCE (PHD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:VACCARO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 N KENDALL DR STE 415
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7565
Mailing Address - Country:US
Mailing Address - Phone:786-251-6022
Mailing Address - Fax:
Practice Address - Street 1:7700 N KENDALL DR STE 415
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7565
Practice Address - Country:US
Practice Address - Phone:786-251-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1287103TS0200X
FLPY10513103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool