Active NPIIndividual provider

Genesis Vergara, PHD

Psychologist, Clinical in Revere, Massachusetts

NPI Number1215636915
Practice location
300 Ocean Ave, Revere, MA 02151-3675
Fax
—
Last updated
September 14, 2026

Genesis Vergara is a Psychologist, Clinical based in Revere, MA. Genesis Vergara practices in Revere, MA and has the professional credentials of PHD. The NPI Number for Genesis Vergara is 1215636915 and holds a License No. PSY10001870 (MA). The current practice location address for Genesis Vergara is 300 Ocean Ave, Revere, MA 02151-3675 and can be reached out via phone at 781-485-6100.

Provider Profile Details

NPI Number
1215636915
Provider Name
Genesis Vergara
Credential
PHD
Provider Entity Type
Individual
Gender
Female
Address
300 Ocean Ave, Revere, MA 02151-3675
Phone Number
781-485-6100
Primary Taxonomy
Psychologist, Clinical · 103TC0700X
Sole Proprietor
No
Provider Enumeration Date
March 1, 2023
Last Update Date
September 14, 2026
Certification Date
September 14, 2026
NPI Status
Active

Provider Business Practice Location Address Details

Address
300 Ocean Ave
Revere, MA 02151-3675
City
Revere
Zip
02151-3675
Phone Number
781-485-6100
Revere, MA 02151Get directions →

Provider Business Mailing Address Details

Address
300 Ocean Ave
Revere, MA 02151-3675
City
Revere
State
MA
Zip
02151-3675
Phone Number
781-485-6100

License Information

License Number
PSY10001870
License State
MA
Taxonomy
Psychologist, Clinical · 103TC0700X · Primary

Legacy Identifiers

IdentifierTypeStateIssuer
No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider.

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Frequently Asked Questions

What is the NPI number of Genesis Vergara, PHD?

The NPI number of Genesis Vergara, PHD is 1215636915. It was assigned on March 1, 2023 and is currently active in the NPPES registry.

What is the specialty of Genesis Vergara, PHD?

Genesis Vergara, PHD is registered under the primary taxonomy Psychologist, Clinical (code 103TC0700X), licensed in MA under license number PSY10001870.

Where does Genesis Vergara, PHD practice?

The practice location is 300 Ocean Ave, Revere, MA 02151-3675. The office can be reached at 781-485-6100 (phone).

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.

How do I verify this NPI record?

This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1215636915 directly on the NPPES registry website.

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