Provider Demographics
NPI:1801028055
Name:VEGA, WILLIAM (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 ALLERTON AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8744
Mailing Address - Country:US
Mailing Address - Phone:718-594-6443
Mailing Address - Fax:
Practice Address - Street 1:736 ALLERTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8744
Practice Address - Country:US
Practice Address - Phone:718-594-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0698861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03428388Medicaid
NYA300063221OtherMEDICARE (PTAN)