Provider Demographics
NPI:1336261593
Name:VERGARA, MICAELA (LCSW)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:VERGARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 PEBBLE BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-1210
Mailing Address - Country:US
Mailing Address - Phone:281-673-6070
Mailing Address - Fax:
Practice Address - Street 1:1454 CAMPBELL RD STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4604
Practice Address - Country:US
Practice Address - Phone:281-673-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical