Provider Demographics
NPI:1053823799
Name:VARGAS, VANESSA GERALDINE (TEACHER)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GERALDINE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MORROW AVE APT 7MN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-8271
Mailing Address - Country:US
Mailing Address - Phone:203-515-0756
Mailing Address - Fax:
Practice Address - Street 1:40 MORROW AVE APT 7MN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-8271
Practice Address - Country:US
Practice Address - Phone:203-515-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY932490151174400000X
932490151252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialist