Provider Demographics
NPI:1407074065
Name:PATRICIA M. WILKINS-VACCA, LCSW, PC
Entity Type:Organization
Organization Name:PATRICIA M. WILKINS-VACCA, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILKINS-VACCA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-527-9456
Mailing Address - Street 1:32 E BANK RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1432
Mailing Address - Country:US
Mailing Address - Phone:845-527-9456
Mailing Address - Fax:845-473-0628
Practice Address - Street 1:504 HAIGHT AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2479
Practice Address - Country:US
Practice Address - Phone:845-527-9456
Practice Address - Fax:845-473-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02469689Medicaid
NY7496661OtherAETNA
NYP2586785OtherOXFORD
NY781305OtherMVP
NY02469689Medicaid
NYP2586785OtherOXFORD