Provider Demographics
NPI:1982627246
Name:VERGALES, ANN LYNN (MSW ACSW LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LYNN
Last Name:VERGALES
Suffix:
Gender:F
Credentials:MSW ACSW LCSW BCD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:LYNN
Other - Last Name:CHOPEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2151 LINGLESTOWN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-540-1313
Mailing Address - Fax:717-540-1416
Practice Address - Street 1:2151 LINGLESTOWN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110
Practice Address - Country:US
Practice Address - Phone:717-540-1313
Practice Address - Fax:717-540-1416
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0123781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01698802OtherCAPITAL BLUE CROSS
S86270Medicare UPIN
064221Medicare ID - Type Unspecified