Provider Demographics
NPI:1740470236
Name:VAGEDES, MARIE ANGELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANGELA
Last Name:VAGEDES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2430 ESTANCIA BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2644
Mailing Address - Country:US
Mailing Address - Phone:727-316-5740
Mailing Address - Fax:833-216-5165
Practice Address - Street 1:2430 ESTANCIA BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2644
Practice Address - Country:US
Practice Address - Phone:727-316-5740
Practice Address - Fax:833-216-5165
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical