Provider Demographics
NPI:1851626584
Name:VARGAS, BROOKE CORINNE (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CORINNE
Last Name:VARGAS
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 1:2900 MAIN ST STE 3DF
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-321-3238
Mailing Address - Fax:203-307-0821
Practice Address - Street 1:2900 MAIN ST STE 3DF
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4946
Practice Address - Country:US
Practice Address - Phone:203-321-3238
Practice Address - Fax:203-307-0821
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical