Provider Demographics
NPI:1154465557
Name:GUARNACCIA, VITO JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:JOHN
Last Name:GUARNACCIA
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 1:206 SEDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5594
Mailing Address - Country:US
Mailing Address - Phone:919-210-3958
Mailing Address - Fax:
Practice Address - Street 1:206 SEDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5594
Practice Address - Country:US
Practice Address - Phone:919-210-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000932Medicaid
NC6000932Medicaid