Provider Demographics
NPI:1942787171
Name:RODRIGUEZ-VARGAS, INDIRA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:RODRIGUEZ-VARGAS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14127 SANCTUARY TERRACE LN UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6643
Mailing Address - Country:US
Mailing Address - Phone:407-968-5955
Mailing Address - Fax:
Practice Address - Street 1:1155 S SEMORAN BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5505
Practice Address - Country:US
Practice Address - Phone:407-968-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional