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General NPI Number Information
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NPI Number | 1932676806
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Entity Type | Individual
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Provider Name | CHRYSTAL VERGARA-LOPEZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 375 WAMPANOAG TRL
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City | RIVERSIDE
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State | RI
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Zip | 02915-2232
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Country | US
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Telephone | 401-649-4050
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Fax | 401-649-4051
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Provider Business Mailing Address
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Address Line | DEPT 3010, PO BOX 986524
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City | BOSTON
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State | MA
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Zip | 02298-6524
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Country | US
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Telephone | 401-443-4992
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Fax | 401-784-4913
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS01743
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License Number State | RI
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