Provider Demographics
NPI:1417205824
Name:VACCARO, ANITA THERESA (MA MFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:THERESA
Last Name:VACCARO
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 CLIFF SHADOWS PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5112
Mailing Address - Country:US
Mailing Address - Phone:702-845-9989
Mailing Address - Fax:
Practice Address - Street 1:10550 W ALEXANDER RD UNIT 2186
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-3522
Practice Address - Country:US
Practice Address - Phone:702-845-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist