Provider Demographics
NPI:1376162024
Name:VEGA RODRIGUEZ, ANGEL RICARDO (MSW, LCSW,)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:RICARDO
Last Name:VEGA RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LA HACIENDA CALLE 46 AT4
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-587-4245
Mailing Address - Fax:
Practice Address - Street 1:URB. LA HACIENDA CALLE 46 AT4
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-587-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR244781041C0700X
PR152861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty