Provider Demographics
NPI:1043528912
Name:VEGA, RAQUEL (PSYD)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3417
Mailing Address - Country:US
Mailing Address - Phone:646-477-3782
Mailing Address - Fax:
Practice Address - Street 1:339 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3417
Practice Address - Country:US
Practice Address - Phone:646-477-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
020597103T00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst