Provider Demographics
NPI:1942574496
Name:VARGAS, VANESSA (MS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1151
Mailing Address - Country:US
Mailing Address - Phone:954-453-6400
Mailing Address - Fax:954-764-6458
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5311
Practice Address - Country:US
Practice Address - Phone:413-316-1446
Practice Address - Fax:413-304-7975
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor