Provider Demographics
NPI:1023607744
Name:VEGA, NOELLE DONAHUE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:DONAHUE
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 THACHER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2008
Mailing Address - Country:US
Mailing Address - Phone:978-239-8984
Mailing Address - Fax:
Practice Address - Street 1:53 PARKER HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3225
Practice Address - Country:US
Practice Address - Phone:978-239-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist