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General NPI Number Information
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NPI Number | 1104004274
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Entity Type | Individual
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Provider Name | MRS. RAQUEL FERNS LEFEBVRE
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Gender | Female
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 05/27/2012
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Provider Practice Location Address
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Address Line | 595 DORSET ST SUITE 2
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6240
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Country | US
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Telephone | 802-651-8999
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Fax | 802-651-8997
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Provider Business Mailing Address
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Address Line | 595 DORSET ST SUITE 2
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6240
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Country | US
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Telephone | 802-651-8999
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Fax | 802-651-8997
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0470000731
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License Number State | VT
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