Provider Demographics
NPI:1447766803
Name:VARGAS, EDUARDO A (LCSW)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:VARGAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 FIRST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3634
Mailing Address - Country:US
Mailing Address - Phone:210-837-7735
Mailing Address - Fax:
Practice Address - Street 1:4302 FIRST VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3634
Practice Address - Country:US
Practice Address - Phone:210-837-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0464214OtherTAX ID
TX381315601Medicaid