Provider Demographics
NPI:1174980429
Name:VACCARO, INESSA
Entity type:Individual
Prefix:MRS
First Name:INESSA
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:INESSA
Other - Middle Name:
Other - Last Name:SHOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:593 EDISON DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5207
Mailing Address - Country:US
Mailing Address - Phone:732-266-9488
Mailing Address - Fax:
Practice Address - Street 1:593 EDISON DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-5207
Practice Address - Country:US
Practice Address - Phone:732-266-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00529000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health