Provider Demographics
NPI:1720402332
Name:BURGOS VEGA, PETER (MFT,LPP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BURGOS VEGA
Suffix:
Gender:M
Credentials:MFT,LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MK17 PASEO DEL PARQUE
Mailing Address - Street 2:MONTE CLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4757
Mailing Address - Country:US
Mailing Address - Phone:787-593-1548
Mailing Address - Fax:
Practice Address - Street 1:MK17 PASEO DEL PARQUE
Practice Address - Street 2:MONTE CLARO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4757
Practice Address - Country:US
Practice Address - Phone:787-593-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist