Provider Demographics
NPI:1003169780
Name:VERGARA, JENNIFER M (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:VERGARA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S HAGER AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4168
Mailing Address - Country:US
Mailing Address - Phone:847-381-0345
Mailing Address - Fax:847-381-9297
Practice Address - Street 1:4722 ARBOR DR APT 207
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4426
Practice Address - Country:US
Practice Address - Phone:312-388-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013629104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362815350OtherBARRINGTON YOUTH & FAMILY SERVICES