Doctor Name: | EUGENE D VACCARO |
NPI Number: | 1144333485 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD |
License Number: | |
Business Practice Address: | 75 E Queenwood Rd Morton, IL - 615502985 |
Business Phone Number: | 3092635565 |
Business Fax Number: | 3092639336 |
Mailing Address: | 4603 S King Arthur Ct, MAPLETON |
State: | IL |
Postal Code: | 615479549 |
Phone Number: | 3092635565 |
Fax Number: | 3092639336 |
NPI Enumeration Date: | 08/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |