Individual
MR. DAVID VACCARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
1006 S DIVISION ST, CARTERVILLE, IL 62918-1539
(618) 519-9200
(618) 985-3774
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918
(618) 519-9200
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149022307
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149022307
INDEPENDENT LICENSE
IL
Enumeration date
02/11/2021
Last updated
09/26/2022
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