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General NPI Number Information
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NPI Number | 1720500663
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Entity Type | Individual
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Provider Name | MAYRA C VEGA
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 14015B SANFORD AVE FL 2
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City | FLUSHING
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State | NY
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Zip | 11355-2557
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Country | US
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Telephone | 185-528-3214
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Fax | 855-283-2146
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Provider Business Mailing Address
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Address Line | 4750 59TH ST APT 1E
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City | WOODSIDE
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State | NY
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Zip | 11377-5517
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Country | US
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Telephone | 917-586-7737
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 102881-1
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License Number State | NY
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