Provider Demographics
NPI:1326768599
Name:VARGAS-HERZFELDT, JOAN E (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:VARGAS-HERZFELDT
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2889
Mailing Address - Country:US
Mailing Address - Phone:630-835-1430
Mailing Address - Fax:
Practice Address - Street 1:1240 IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1034
Practice Address - Country:US
Practice Address - Phone:224-141-1390
Practice Address - Fax:224-414-1290
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490252751041C0700X
IL150102569104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical