MEDICARE: STEPHANIE VEGA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW21201	FL

General Provider Information

NPI Number	:	1306548193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE VEGA LCSW

Provider Business Mailing Address
First Line	:	161 2ND ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1713
Country	:	US
Telephone Number	:	561-900-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 2ND ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1713
Country	:	US
Telephone Number	:	561-900-8945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/17/2023

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