Provider Demographics
NPI:1265237242
Name:VARGAS, DAVID (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:6 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-9742
Mailing Address - Country:US
Mailing Address - Phone:773-526-3081
Mailing Address - Fax:
Practice Address - Street 1:1906 N JOHGN YOUNG PARKWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:407-910-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor