Healthcare Provider Details

I. General information

NPI: 1639557754
Provider Name (Legal Business Name): MARIA VEGA LCSW 112833
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 09/26/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 SHERMAN CIR
VAN NUYS CA
91405-3087
US

IV. Provider business mailing address

1005 DE HAVEN ST
SAN FERNANDO CA
91340-2130
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4930
  • Fax:
Mailing address:
  • Phone: 818-259-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: