Provider Demographics
NPI:1184026650
Name:VARGAS, BRIDGET L (SEIT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:L
Last Name:VARGAS
Suffix:
Gender:F
Credentials:SEIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4312
Mailing Address - Country:US
Mailing Address - Phone:347-992-7932
Mailing Address - Fax:
Practice Address - Street 1:1715 COLEMAN STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:347-992-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760707131251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1902872591OtherSEIT