Provider Demographics
NPI:1659057966
Name:VERGARA-BERENDA, NATALIA D (LCSW)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:D
Last Name:VERGARA-BERENDA
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 1:701 E WILLOW ST APT 20201
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-1736
Mailing Address - Country:US
Mailing Address - Phone:191-734-9743
Mailing Address - Fax:
Practice Address - Street 1:701 E WILLOW ST APT 20201
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-1736
Practice Address - Country:US
Practice Address - Phone:917-349-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0234511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical