Healthcare Provider Details

I. General information

NPI: 1760296529
Provider Name (Legal Business Name): VUEX-CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SE 2ND ST
MILFORD DE
19963-1901
US

IV. Provider business mailing address

560 S DUPONT BLVD
MILFORD DE
19963-1758
US

V. Phone/Fax

Practice location:
  • Phone: 302-538-1861
  • Fax:
Mailing address:
  • Phone: 302-538-1861
  • Fax: 302-600-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA R WATERS
Title or Position: LCSW
Credential:
Phone: 302-396-8231