Provider Demographics
NPI:1922719947
Name:VARGHESE, REBECCA LEWIS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEWIS
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79780 MIRA FLORES BLVD
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8204
Mailing Address - Country:US
Mailing Address - Phone:843-422-1383
Mailing Address - Fax:
Practice Address - Street 1:79780 MIRA FLORES BLVD
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8204
Practice Address - Country:US
Practice Address - Phone:843-422-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1122481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical