Provider Demographics
NPI:1639387301
Name:WEBB, VAUGHN (CRC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VAUGHN
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:CRC, LMHC
Other - Prefix:MRS
Other - First Name:JIMMIE
Other - Middle Name:V
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRC, LMHC
Mailing Address - Street 1:444 E 86TH ST APT 26A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6480
Mailing Address - Country:US
Mailing Address - Phone:212-879-2731
Mailing Address - Fax:
Practice Address - Street 1:937 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2347
Practice Address - Country:US
Practice Address - Phone:718-789-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18000738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health