Provider Demographics
NPI:1285344143
Name:JOE VEGA LLC
Entity type:Organization
Organization Name:JOE VEGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-227-5171
Mailing Address - Street 1:4209 CANAL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5942
Mailing Address - Country:US
Mailing Address - Phone:504-272-7035
Mailing Address - Fax:985-781-4319
Practice Address - Street 1:4209 CANAL ST STE 202
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5942
Practice Address - Country:US
Practice Address - Phone:504-272-7035
Practice Address - Fax:985-781-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2406850Medicaid