Provider Demographics
NPI:1578016036
Name:VACCARO, KATHRYN (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NEWKIRK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1312
Mailing Address - Country:US
Mailing Address - Phone:516-503-6416
Mailing Address - Fax:
Practice Address - Street 1:511 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2737
Practice Address - Country:US
Practice Address - Phone:516-565-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist