Provider Demographics
NPI:1437510203
Name:VARGO, MARISA (MS CF-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:VARGO
Suffix:
Gender:F
Credentials:MS CF-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5902
Mailing Address - Country:US
Mailing Address - Phone:718-238-2765
Mailing Address - Fax:718-238-2765
Practice Address - Street 1:8804 5TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5902
Practice Address - Country:US
Practice Address - Phone:718-238-7451
Practice Address - Fax:718-238-2765
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist