Provider Demographics
NPI:1184675662
Name:VARGAS, JUDY LYNN HINE (LISW LCSW LPCC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN HINE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LISW LCSW LPCC
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:LYNN HINE
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW LPCC
Mailing Address - Street 1:314 DON FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5953
Mailing Address - Country:US
Mailing Address - Phone:575-751-7037
Mailing Address - Fax:
Practice Address - Street 1:314 DON FERNANDO ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5953
Practice Address - Country:US
Practice Address - Phone:575-751-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0078031101Y00000X, 101YP2500X
NMI05887104100000X
NMC058871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34624279Medicaid
NM34624279Medicaid