1093696015 NPI number — DISCOVERY TEXAS INTERVENTIONAL PSYCHIATRY PLLC

Table of content: (NPI 1093696015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093696015 NPI number — DISCOVERY TEXAS INTERVENTIONAL PSYCHIATRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOVERY TEXAS INTERVENTIONAL PSYCHIATRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1093696015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3940 CAPITOL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-752-6643
Provider Business Mailing Address Fax Number:
305-930-7437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3940 CAPITOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-752-6643
Provider Business Practice Location Address Fax Number:
305-930-7437
Provider Enumeration Date:
09/08/2025

Additional Information

Authorized Official

Authorized Official Last Name:
VACCARO
Authorized Official First Name:
JERROME
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
214-736-1118

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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