Provider Demographics
NPI:1770569360
Name:WILKINS-VACCA, PATRICIA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:WILKINS-VACCA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E BANK RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1432
Mailing Address - Country:US
Mailing Address - Phone:845-527-9456
Mailing Address - Fax:845-473-0628
Practice Address - Street 1:15 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7212
Practice Address - Country:US
Practice Address - Phone:845-527-9456
Practice Address - Fax:845-473-0628
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0694521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2586785OtherOXFORD PROVIDER #
NY02469689Medicaid
NY781305OtherMVP PROVIDER #
NYP2586785OtherOXFORD PROVIDER #
NY02469689Medicaid