Provider Demographics
NPI:1568153674
Name:GARCIA DE LA VEGA, AMY (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GARCIA DE LA VEGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3058 W BELMONT AVE UNIT 2D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5707
Mailing Address - Country:US
Mailing Address - Phone:312-834-7102
Mailing Address - Fax:
Practice Address - Street 1:3058 W BELMONT AVE UNIT 2D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5707
Practice Address - Country:US
Practice Address - Phone:312-834-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker