Provider Demographics
NPI:1225192735
Name:VACCARO, LAURA NAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NAN
Last Name:VACCARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 80TH ST APT 21
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2735
Mailing Address - Country:US
Mailing Address - Phone:718-899-6452
Mailing Address - Fax:
Practice Address - Street 1:8108 37TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6751
Practice Address - Country:US
Practice Address - Phone:718-406-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05974Medicare ID - Type Unspecified