Provider Demographics
NPI:1417152992
Name:VERGARA, ALEJANDRA INEZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEJANDRA
Middle Name:INEZ
Last Name:VERGARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 VANPORT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1524
Mailing Address - Country:US
Mailing Address - Phone:408-686-2369
Mailing Address - Fax:408-848-4370
Practice Address - Street 1:97 E SAINT JAMES ST APT 28
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4059
Practice Address - Country:US
Practice Address - Phone:408-808-5221
Practice Address - Fax:408-848-4370
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 180901041C0700X
CA289601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical