Provider Demographics
NPI:1558704973
Name:VEGA, JOSE IGNACIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:IGNACIO
Last Name:VEGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5534 PRATT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2643
Mailing Address - Country:US
Mailing Address - Phone:908-227-5171
Mailing Address - Fax:985-781-4319
Practice Address - Street 1:4209 CANAL ST STE 202
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5942
Practice Address - Country:US
Practice Address - Phone:504-272-7035
Practice Address - Fax:504-814-6047
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2406850Medicaid