Provider Demographics
NPI:1093868218
Name:VEGA, EVELYN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 BARKER AVE
Mailing Address - Street 2:1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8052
Mailing Address - Country:US
Mailing Address - Phone:347-275-3457
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN MEDICAL AND MENTAL HEALTH CENTER
Practice Address - Street 2:234 E. 149 STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5657
Practice Address - Fax:718-579-5310
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0410081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical