Provider Demographics
NPI:1346552221
Name:VARGAS, WILHELMINA P (LCSW, CSSW)
Entity Type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:P
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LCSW, CSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2510
Mailing Address - Country:US
Mailing Address - Phone:732-246-8439
Mailing Address - Fax:732-246-8051
Practice Address - Street 1:8 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2510
Practice Address - Country:US
Practice Address - Phone:732-246-8439
Practice Address - Fax:732-246-8051
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6120691041S0200X
NJ44SC055007001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222 59-7759OtherTAX ID