Provider Demographics
NPI:1164114112
Name:VARGO, CAITLIN (LSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:VARGO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 DRESSLER RD NW STE 112
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2576
Mailing Address - Country:US
Mailing Address - Phone:330-765-5160
Mailing Address - Fax:440-527-8043
Practice Address - Street 1:4565 DRESSLER RD NW STE 112
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2576
Practice Address - Country:US
Practice Address - Phone:330-765-5160
Practice Address - Fax:440-527-8043
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2107188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker