Provider Demographics
NPI:1902073869
Name:VEGA, MARYORIE (MSW)
Entity Type:Individual
Prefix:
First Name:MARYORIE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AVE LIBORIO LOPEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2036
Mailing Address - Country:US
Mailing Address - Phone:787-215-3653
Mailing Address - Fax:
Practice Address - Street 1:184 CALLE GUADALUPE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3561
Practice Address - Country:US
Practice Address - Phone:787-753-9515
Practice Address - Fax:787-753-8327
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8903104100000X
PR5616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker