Provider Demographics
NPI:1003872383
Name:VANACORE, MARK C (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:VANACORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 LITTLE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-5000
Mailing Address - Country:US
Mailing Address - Phone:203-453-4457
Mailing Address - Fax:
Practice Address - Street 1:871 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3923
Practice Address - Country:US
Practice Address - Phone:203-776-9900
Practice Address - Fax:203-387-8522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional