Provider Demographics
NPI:1366834681
Name:CHEVERE VEGA, BETH MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MARIE
Last Name:CHEVERE 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 1:3 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1832
Mailing Address - Country:US
Mailing Address - Phone:305-609-7506
Mailing Address - Fax:
Practice Address - Street 1:3 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1832
Practice Address - Country:US
Practice Address - Phone:305-609-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000114104100000X
CTC0620130009001041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool