Provider Demographics
NPI:1417306481
Name:VARGAS, GLORIMAR (CPL)
Entity Type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 871
Mailing Address - Street 2:CALLE 14 KM15 CALLE SARGENTO SANTIAGO
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-714-2462
Mailing Address - Fax:787-735-3233
Practice Address - Street 1:CARR 14 KM. 15 INT
Practice Address - Street 2:CALLE SARGENTO GERARDO SANTIAGO
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:787-735-3233
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health