Healthcare Provider Details

I. General information

NPI: 1124923321
Provider Name (Legal Business Name): BETHANY NOELLE VEGA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N DELSEA DR
VINELAND NJ
08360-2291
US

IV. Provider business mailing address

732 N DELSEA DR
CLAYTON NJ
08312-1266
US

V. Phone/Fax

Practice location:
  • Phone: 856-794-1011
  • Fax: 856-794-1239
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07442700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: