Basic Information
| Provider Information | |||||||||
| NPI: | 1093868218 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VEGA | ||||||||
| FirstName: | EVELYN | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 BARKER AVE | ||||||||
| Address2: | 1B | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104678052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472753457 | ||||||||
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| Practice Location | |||||||||
| Address1: | LINCOLN MEDICAL AND MENTAL HEALTH CENTER | ||||||||
| Address2: | 234 E. 149 STREET | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795657 | ||||||||
| FaxNumber: | 7185795310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R041008 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.