Provider Demographics
NPI:1811887961
Name:VEGA, MYREDIS (LCDA)
Entity type:Individual
Prefix:
First Name:MYREDIS
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:MYREDIS
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDA
Mailing Address - Street 1:HC 2 BOX 5074
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9610
Mailing Address - Country:US
Mailing Address - Phone:939-402-1116
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 5074
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9610
Practice Address - Country:US
Practice Address - Phone:939-402-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8609103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling