Provider Demographics
NPI:1538309208
Name:VERGNE, EDGAR IVAN (MED)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:IVAN
Last Name:VERGNE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1011
Mailing Address - Country:US
Mailing Address - Phone:413-783-6521
Mailing Address - Fax:
Practice Address - Street 1:7 OPEN SQUARE WAY
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5835
Practice Address - Country:US
Practice Address - Phone:413-536-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health