Provider Demographics
NPI:1275132680
Name:VARGAS, ANGELICA MARIA (MA, CJ)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:MARIA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MA, CJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 AMERICANA BLVD APT 32F
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2297
Mailing Address - Country:US
Mailing Address - Phone:787-948-1430
Mailing Address - Fax:
Practice Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5161
Practice Address - Country:US
Practice Address - Phone:407-720-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health