Provider Demographics
NPI:1861607715
Name:VINCENT P. VECERA
Entity type:Organization
Organization Name:VINCENT P. VECERA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VECERA
Authorized Official - Suffix:
Authorized Official - Credentials:HSPP
Authorized Official - Phone:765-966-1180
Mailing Address - Street 1:600 E MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4300
Mailing Address - Country:US
Mailing Address - Phone:765-966-1180
Mailing Address - Fax:765-966-4626
Practice Address - Street 1:600 E MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4300
Practice Address - Country:US
Practice Address - Phone:765-966-1180
Practice Address - Fax:765-966-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20050003A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000189142OtherANTHEM
IN100425720Medicaid
IN060245000OtherMAGELLAN HEALTH
IN075120Medicare ID - Type Unspecified