Provider Demographics
NPI:1497084891
Name:VARGHESE, SANTHOSH (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:SANTHOSH
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-52
Mailing Address - Street 2:263 RD STREET , GLENOAKS
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-347-0206
Mailing Address - Fax:
Practice Address - Street 1:79-52
Practice Address - Street 2:263 RD STREET , GLENOAKS
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-347-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071436104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker