Provider Demographics
NPI:1003213802
Name:VACTOR, RICHARD I (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:VACTOR
Suffix:I
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MADELEINE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3615
Mailing Address - Country:US
Mailing Address - Phone:914-349-3723
Mailing Address - Fax:
Practice Address - Street 1:177 EAST 122ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-360-7116
Practice Address - Fax:212-360-7183
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0796471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical