Provider Demographics
NPI:1427561968
Name:VEGA, BRITTANY LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNN
Last Name:VEGA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:ABDALLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:343 WOODLAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6242
Mailing Address - Country:US
Mailing Address - Phone:507-289-2089
Mailing Address - Fax:
Practice Address - Street 1:343 WOODLAKE DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6242
Practice Address - Country:US
Practice Address - Phone:507-289-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64747104100000X
MN224421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker