Provider Demographics
NPI:1942883848
Name:VACCARINO, GIANNA T
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:T
Last Name:VACCARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4134
Mailing Address - Country:US
Mailing Address - Phone:914-774-0258
Mailing Address - Fax:
Practice Address - Street 1:119 DIXON RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4134
Practice Address - Country:US
Practice Address - Phone:914-774-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010461-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health