Provider Demographics
NPI:1790194959
Name:VARGAS, SUSANA YAZMIN (MA)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:YAZMIN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S QUENTIN RD
Mailing Address - Street 2:103
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6778
Mailing Address - Country:US
Mailing Address - Phone:847-485-3068
Mailing Address - Fax:847-359-7525
Practice Address - Street 1:721 S QUENTIN RD
Practice Address - Street 2:103
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6778
Practice Address - Country:US
Practice Address - Phone:847-485-3068
Practice Address - Fax:847-359-7525
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health