Provider Demographics
NPI:1083755268
Name:VARGAS, KIMBERLY ERIN (CW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ERIN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:CW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WICK LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3338
Mailing Address - Country:US
Mailing Address - Phone:267-568-7846
Mailing Address - Fax:
Practice Address - Street 1:602 S BETHLEHEM PIKE
Practice Address - Street 2:BUILDING B
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5809
Practice Address - Country:US
Practice Address - Phone:267-568-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7745549OtherAETNA
PA262076000Medicaid
PA2321217000OtherPERSONAL CHOICE
PA262076000OtherMAGELLAN
PA2321217000OtherPERSONAL CHOICE