Individual
DOROTHY MARY VACCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D.
Contact information
Practice address
98 RAFFAELE DR, WALTHAM, MA 02452-0313
(781) 899-2091
(781) 899-2091
Mailing address
98 RAFFAELE DR, WALTHAM, MA 02452-0313
(781) 899-2091
(781) 899-2091
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4377
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WO4261
BLUE CROSS BLUE SHIELD PR
MI
Enumeration date
07/13/2006
Last updated
07/08/2007
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