Provider Demographics
NPI:1225862253
Name:VEGA, JULIA (LMSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 58TH AVE APT 2K
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3710
Mailing Address - Country:US
Mailing Address - Phone:917-682-0133
Mailing Address - Fax:
Practice Address - Street 1:550 W B ST FL 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3537
Practice Address - Country:US
Practice Address - Phone:845-250-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080673-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker