MEDICARE: LIDIA M VEGA CHAVIRA LMSW

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	104100000X	Social Worker	SWB-2025--1125	NM
2	171M00000X	Case Manager/Care Coordinator
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2023-0325	NM

General Provider Information

NPI Number	:	1801565445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA M VEGA CHAVIRA LMSW

Provider Business Mailing Address
First Line	:	1403 S MESILLA ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-4944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 S MESILLA ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-4944
Country	:	US
Telephone Number	:	575-332-1312
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	05/26/2026

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