Provider Demographics
NPI:1508327495
Name:RODRIGUEZ VARGAS, VANESSA VICTORIA (PSYAD, LMHC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:VICTORIA
Last Name:RODRIGUEZ VARGAS
Suffix:
Gender:
Credentials:PSYAD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DERNE ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4203
Mailing Address - Country:US
Mailing Address - Phone:617-903-0968
Mailing Address - Fax:857-219-2227
Practice Address - Street 1:10 DERNE ST STE 402
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4203
Practice Address - Country:US
Practice Address - Phone:617-903-0968
Practice Address - Fax:857-219-2227
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000230103TC0700X, 103TC1900X, 103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist