Provider Demographics
NPI:1093717399
Name:VECCHIO, ERNIE L (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:ERNIE
Middle Name:L
Last Name:VECCHIO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 POPLAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9788
Mailing Address - Country:US
Mailing Address - Phone:304-757-8133
Mailing Address - Fax:
Practice Address - Street 1:400 A PRESTIGE PARK
Practice Address - Street 2:
Practice Address - City:TEAYS VALLEY
Practice Address - State:WV
Practice Address - Zip Code:25569
Practice Address - Country:US
Practice Address - Phone:304-561-8217
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical