Provider Demographics
NPI:1356748974
Name:VEGA A. LALIRE PSYCHOLOGIST P.C.
Entity type:Organization
Organization Name:VEGA A. LALIRE PSYCHOLOGIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VEGA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LALIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-615-1004
Mailing Address - Street 1:261 GREENWICH AVE
Mailing Address - Street 2:P.O. BOX 1026
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2028
Mailing Address - Country:US
Mailing Address - Phone:845-615-1004
Mailing Address - Fax:845-615-1029
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508953811OtherINDIVIDUAL NPI