Provider Demographics
NPI:1164516118
Name:VACCARO, AMY KATHARINE (MSS LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHARINE
Last Name:VACCARO
Suffix:
Gender:F
Credentials:MSS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3052
Mailing Address - Country:US
Mailing Address - Phone:610-566-3484
Mailing Address - Fax:610-672-9814
Practice Address - Street 1:205 N. MONROE ST.
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-566-3484
Practice Address - Fax:610-672-9814
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101791815Medicaid