Provider Demographics
NPI:1922141639
Name:VEGA-HENSCHEN, ACECILIA (MS, MA, NCSP)
Entity Type:Individual
Prefix:MS
First Name:ACECILIA
Middle Name:
Last Name:VEGA-HENSCHEN
Suffix:
Gender:F
Credentials:MS, MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 E SAINT ANNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5359
Mailing Address - Country:US
Mailing Address - Phone:602-431-6640
Mailing Address - Fax:602-431-6887
Practice Address - Street 1:4525 E SAINT ANNE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5359
Practice Address - Country:US
Practice Address - Phone:602-431-6640
Practice Address - Fax:602-431-6887
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2696999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist