Provider Demographics
NPI:1871192278
Name:VEGA, JANELLE LEIGH
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:LEIGH
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7181 APPLEBY DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6507
Mailing Address - Country:US
Mailing Address - Phone:912-410-8417
Mailing Address - Fax:
Practice Address - Street 1:7181 APPLEBY DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6507
Practice Address - Country:US
Practice Address - Phone:912-410-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140761106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician