Provider Demographics
NPI:1215170162
Name:VEGA, RICHARD J (LCSW -R)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:VEGA
Suffix:
Gender:M
Credentials:LCSW -R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROUTE 32
Mailing Address - Street 2:2ND FL, SUITE 206
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 ROUTE 32
Practice Address - Street 2:2ND FLOOR, SUITE 206
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3650
Practice Address - Country:US
Practice Address - Phone:917-855-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical