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General NPI Number Information
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NPI Number | 1134545338
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Entity Type | Individual
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Provider Name | IRAIDA L VEGA LPC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | CARR 174, F80 URB. AGUSTIN STAHL
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-884-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 15 AVE 4 URB. LOS ROSALES III
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City | MANATI
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State | PR
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Zip | 00674
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Country | US
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Telephone | 787-884-0883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4032
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License Number State | PR
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