Provider Demographics
NPI:1679044168
Name:VEGA, ZOENIETE IVETTE (MED,LMHC)
Entity Type:Individual
Prefix:
First Name:ZOENIETE
Middle Name:IVETTE
Last Name:VEGA
Suffix:
Gender:F
Credentials:MED,LMHC
Other - Prefix:
Other - First Name:ZOENIETE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED,LMHC
Mailing Address - Street 1:4911 W SAMPLE RD APT 407
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3439
Mailing Address - Country:US
Mailing Address - Phone:646-730-7812
Mailing Address - Fax:
Practice Address - Street 1:529 E CROWN POINT RD STE 120
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3618
Practice Address - Country:US
Practice Address - Phone:305-305-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22528101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50030124Medicaid