Provider Demographics
NPI:1720634017
Name:VACCARO, ANGEL (LPC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 MONROE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2477
Mailing Address - Country:US
Mailing Address - Phone:570-483-8956
Mailing Address - Fax:
Practice Address - Street 1:224 KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2860
Practice Address - Country:US
Practice Address - Phone:808-825-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health