Provider Demographics
NPI:1316083553
Name:VACCARO, VINCENT (PHD)
Entity type:Individual
Prefix:
First Name:VINCENT
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 1:163 ENGLE ST
Mailing Address - Street 2:BLDG 1
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2535
Mailing Address - Country:US
Mailing Address - Phone:201-567-4551
Mailing Address - Fax:291-945-1568
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:BLDG 1
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-567-4551
Practice Address - Fax:291-945-1568
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007145-1103TA0400X
NJSI 00290200103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472378Medicare ID - Type Unspecified