Provider Demographics
NPI:1174642094
Name:VARGO, HEATHER LEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEA
Last Name:VARGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2924
Mailing Address - Country:US
Mailing Address - Phone:610-983-3367
Mailing Address - Fax:610-983-9130
Practice Address - Street 1:183 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1740
Practice Address - Country:US
Practice Address - Phone:484-527-0181
Practice Address - Fax:484-527-0116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0133061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0135867000OtherMHS #