Provider Demographics
NPI:1104004274
Name:LEFEBVRE, RAQUEL FERNS
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:FERNS
Last Name:LEFEBVRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 DORSET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6240
Mailing Address - Country:US
Mailing Address - Phone:802-651-8999
Mailing Address - Fax:802-651-8997
Practice Address - Street 1:595 DORSET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6240
Practice Address - Country:US
Practice Address - Phone:802-651-8999
Practice Address - Fax:802-651-8997
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047-0000731OtherLICENSED PSYCHOLOGIST