Provider Demographics
NPI:1801101399
Name:VEGA, DINANDREA (LCSW, CSOTP)
Entity type:Individual
Prefix:MS
First Name:DINANDREA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S EL MOLINO AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2543
Mailing Address - Country:US
Mailing Address - Phone:323-641-1764
Mailing Address - Fax:
Practice Address - Street 1:520 S GRAND AVE STE 680
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2655
Practice Address - Country:US
Practice Address - Phone:323-334-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065951041C0700X
CA703861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical