Provider Demographics
NPI:1518080167
Name:VINACCO, RICHARD JR (PSYD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:VINACCO
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3105
Mailing Address - Country:US
Mailing Address - Phone:401-921-9485
Mailing Address - Fax:401-921-1485
Practice Address - Street 1:57 GILLAN AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3105
Practice Address - Country:US
Practice Address - Phone:401-921-9485
Practice Address - Fax:401-921-1485
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPSOO562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0525162Medicare UPIN