Provider Demographics
NPI:1346875077
Name:VARGAS ECHEVARRIA, RICARDO JAVIER SR (MASTER IN SOCIAL WOR)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JAVIER
Last Name:VARGAS ECHEVARRIA
Suffix:SR
Gender:M
Credentials:MASTER IN SOCIAL WOR
Other - Prefix:MR
Other - First Name:RICARDO
Other - Middle Name:JAVIER
Other - Last Name:VARGAS-ECHEVARRIA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:95 FRANK B MURRAY ST.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103
Mailing Address - Country:US
Mailing Address - Phone:413-285-8586
Mailing Address - Fax:
Practice Address - Street 1:95 FRANK B MURRAY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1106
Practice Address - Country:US
Practice Address - Phone:413-285-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
PR6183108104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6183108Medicaid