Provider Demographics
NPI:1508953811
Name:LALIRE, VEGA (PHD)
Entity Type:Individual
Prefix:
First Name:VEGA
Middle Name:
Last Name:LALIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SQUADRON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5214
Mailing Address - Country:US
Mailing Address - Phone:845-213-1495
Mailing Address - Fax:845-634-9424
Practice Address - Street 1:261 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2028
Practice Address - Country:US
Practice Address - Phone:845-615-1004
Practice Address - Fax:845-615-1029
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53457Medicare UPIN