Provider Demographics
NPI:1013643709
Name:VEGA-CABRERA, JESUS MANUEL (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MANUEL
Last Name:VEGA-CABRERA
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 WASHINGTON AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-4307
Mailing Address - Country:US
Mailing Address - Phone:917-645-8073
Mailing Address - Fax:
Practice Address - Street 1:3 COTTAGE PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4201
Practice Address - Country:US
Practice Address - Phone:914-235-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37998101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7851Medicaid